HF 1814

1st Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/25/2024 10:12am

A bill for an act
relating to health; modifying provisions governing medical debt; establishing
requirements for billing and payment for miscoded health treatments and services;
prohibiting certain practices related to collecting medical debt; providing for
enforcement; amending Minnesota Statutes 2022, sections 334.01, by adding a
subdivision; 519.05; Minnesota Statutes 2023 Supplement, sections 144.587,
subdivisions 1, 4; 270A.03, subdivision 2; proposing coding for new law in
Minnesota Statutes, chapters 62J; 332; proposing coding for new law as Minnesota
Statutes, chapter 332C.

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

Section 1.

new text begin [62J.805] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin For purposes of sections 62J.805 to 62J.808, the following
terms have the meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Group practice. new text end

new text begin "Group practice" has the meaning given to health care provider
group practice in section 145D.01, subdivision 1.
new text end

new text begin Subd. 3. new text end

new text begin Health care provider. new text end

new text begin "Health care provider" means:
new text end

new text begin (1) a health professional who is licensed or registered by the state to provide health
treatments and services within the professional's scope of practice and in accordance with
state law;
new text end

new text begin (2) a group practice; or
new text end

new text begin (3) a hospital.
new text end

new text begin Subd. 4. new text end

new text begin Health plan. new text end

new text begin "Health plan" has the meaning given in section 62A.011,
subdivision 3.
new text end

new text begin Subd. 5. new text end

new text begin Hospital. new text end

new text begin "Hospital" means a health care facility licensed as a hospital under
sections 144.50 to 144.56.
new text end

new text begin Subd. 6. new text end

new text begin Medically necessary. new text end

new text begin "Medically necessary" means:
new text end

new text begin (1) safe and effective;
new text end

new text begin (2) not experimental or investigational, except as provided in Code of Federal Regulations,
title 42, section 411.15(o);
new text end

new text begin (3) furnished in accordance with acceptable medical standards of medical practice for
the diagnosis or treatment of the patient's condition or to improve the function of a malformed
body member;
new text end

new text begin (4) furnished in a setting appropriate to the patient's medical need and condition;
new text end

new text begin (5) ordered and furnished by qualified personnel;
new text end

new text begin (6) meets, but does not exceed, the patient's medical need; and
new text end

new text begin (7) is at least as beneficial as an existing and available medically appropriate alternative.
new text end

new text begin Subd. 7. new text end

new text begin Miscode. new text end

new text begin "Miscode" means a health care provider or a health care provider's
designee, using a coding system and for billing purposes, assigns a numeric or alphanumeric
code to a health treatment or service provided to a patient and the code assigned does not
accurately reflect the health treatment or service provided based on factors that include the
patient's diagnosis and the complexity of the patient's condition.
new text end

new text begin Subd. 8. new text end

new text begin Payment. new text end

new text begin "Payment" includes co-payments and coinsurance and deductible
payments made by a patient.
new text end

Sec. 2.

new text begin [62J.806] POLICY FOR COLLECTION OF MEDICAL DEBT.
new text end

new text begin Subdivision 1. new text end

new text begin Requirement. new text end

new text begin Each health care provider must make available to the
public the health care provider's policy for the collection of medical debt from patients. This
policy must be made available by:
new text end

new text begin (1) clearly posting it on the health care provider's website or, for health professionals,
on the website of the health clinic, group practice, or hospital at which the health professional
is employed or under contract; and
new text end

new text begin (2) providing a copy of the policy to any individual who requests it.
new text end

new text begin Subd. 2. new text end

new text begin Content. new text end

new text begin A policy made available under this section must at least specify the
procedures followed by the health care provider for:
new text end

new text begin (1) communicating with patients about the medical debt owed and collecting medical
debt;
new text end

new text begin (2) referring medical debt to a collection agency or law firm for collection; and
new text end

new text begin (3) identifying medical debt as uncollectible or satisfied, and ending collection activities.
new text end

Sec. 3.

new text begin [62J.807] DENIAL OF HEALTH TREATMENTS OR SERVICES DUE TO
OUTSTANDING MEDICAL DEBT.
new text end

new text begin (a) A health care provider must not deny medically necessary health treatments or services
to a patient or any member of the patient's family or household because of outstanding
medical debt owed by the patient or any member of the patient's family or household to the
health care provider, regardless of whether the health treatment or service may be available
from another health care provider.
new text end

new text begin (b) As a condition of providing medically necessary health treatments or services in the
circumstances described in paragraph (a), a health care provider may require the patient to
enroll in a payment plan for the outstanding medical debt owed to the health care provider.
new text end

Sec. 4.

new text begin [62J.808] BILLING AND PAYMENT FOR MISCODED HEALTH
TREATMENTS AND SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Participation and cooperation required. new text end

new text begin Each health care provider
must participate in, and cooperate with, all processes and investigations to identify, review,
and correct the coding of health treatments and services that are miscoded by the health
care provider or a designee.
new text end

new text begin Subd. 2. new text end

new text begin Notice; billing and payment during review. new text end

new text begin (a) When a health care provider
receives notice, other than notice from a health plan company as provided in paragraph (b),
or otherwise determines that a health treatment or service may have been miscoded, the
health care provider must notify the health plan company administering the patient's health
plan in a timely manner of the potentially miscoded health treatment or service.
new text end

new text begin (b) When a health plan company receives notice, other than notice from a health care
provider as provided in paragraph (a), or otherwise determines that a health treatment or
service may have been miscoded, the health plan company must notify the health care
provider who provided the health treatment or service of the potentially miscoded health
treatment or service.
new text end

new text begin (c) When a review of a potentially miscoded health treatment or service is commenced,
the health care provider and health plan company must notify the patient that a miscoding
review is being conducted and that the patient will not be billed for any health treatment or
service subject to the review and is not required to submit payments for any health treatment
or service subject to the review until the review is complete and any miscoded health
treatments or services are correctly coded.
new text end

new text begin (d) While a review of a potentially miscoded health treatment or service is being
conducted, the health care provider and health plan company must not bill the patient for,
or accept payment from the patient for, any health treatment or service subject to the review.
new text end

new text begin Subd. 3. new text end

new text begin Billing and payment after completion of review. new text end

new text begin The health care provider
and health plan company may bill the patient for, and accept payment from the patient for,
the health treatment or service that was subject to the miscoding review only after the review
is complete and any miscoded health treatments or services have been correctly coded.
new text end

Sec. 5.

Minnesota Statutes 2023 Supplement, section 144.587, subdivision 1, is amended
to read:

Subdivision 1.

Definitions.

(a) The terms defined in this subdivision apply to this section
and sections 144.588 to 144.589.

(b) "Charity care" means the provision of free or discounted care to a patient according
to a hospital's financial assistance policies.

(c) "Hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56.

(d) "Insurance affordability program" has the meaning given in section 256B.02,
subdivision 19.

(e) "Navigator" has the meaning given in section 62V.02, subdivision 9.

(f) "Presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.

deleted text begin (g) "Revenue recapture" means the use of the procedures in chapter deleted text end deleted text begin 270A deleted text end deleted text begin to collect debt.
deleted text end

deleted text begin (h) deleted text end new text begin (g) new text end "Uninsured service or treatment" means any service or treatment that is not
covered by:

(1) a health plan, contract, or policy that provides health coverage to a patient; or

(2) any other type of insurance coverage, including but not limited to no-fault automobile
coverage, workers' compensation coverage, or liability coverage.

deleted text begin (i) deleted text end new text begin (h) new text end "Unreasonable burden" includes requiring a patient to apply for enrollment in a
state or federal program for which the patient is obviously or categorically ineligible or has
been found to be ineligible in the previous 12 months.

Sec. 6.

Minnesota Statutes 2023 Supplement, section 144.587, subdivision 4, is amended
to read:

Subd. 4.

Prohibited actions.

new text begin (a) new text end A hospital must not initiate one or more of the following
actions until the hospital determines that the patient is ineligible for charity care or denies
an application for charity care:

(1) offering to enroll or enrolling the patient in a payment plan;

(2) changing the terms of a patient's payment plan;

(3) offering the patient a loan or line of credit, application materials for a loan or line of
credit, or assistance with applying for a loan or line of credit, for the payment of medical
debt;

(4) referring a patient's debt for collections, including in-house collections, third-party
collections, deleted text begin revenue recapture, deleted text end or any other process for the collection of debt; new text begin or
new text end

deleted text begin (5) denying health care services to the patient or any member of the patient's household
because of outstanding medical debt, regardless of whether the services are deemed necessary
or may be available from another provider; or
deleted text end

deleted text begin (6) deleted text end new text begin (5) new text end accepting a credit card payment of over $500 for the medical debt owed to the
hospital.

new text begin (b) A hospital is subject to section 62J.807.
new text end

Sec. 7.

Minnesota Statutes 2023 Supplement, section 270A.03, subdivision 2, is amended
to read:

Subd. 2.

Claimant agency.

"Claimant agency" means any state agency, as defined by
section 14.02, subdivision 2, the regents of the University of Minnesota, any district court
of the state, any county, any statutory or home rule charter city, including a city that is
presenting a claim for deleted text begin a municipal hospital or deleted text end a public library deleted text begin or a municipal ambulance
service, a hospital district, any ambulance service licensed under chapter 144E deleted text end , any public
agency responsible for child support enforcement, any public agency responsible for the
collection of court-ordered restitution, and any public agency established by general or
special law that is responsible for the administration of a low-income housing program.

Sec. 8.

new text begin [332.371] MEDICAL DEBT CREDIT REPORTING PROHIBITED.
new text end

new text begin (a) A consumer reporting agency is prohibited from making a consumer report containing
an item of information that the consumer reporting agency knows or should know concerns
(1) medical information; or (2) debt arising from: (i) the provision of medical care, treatment,
services, devices, or medicines; or (ii) procedures to maintain, diagnose, or treat a person's
physical or mental health.
new text end

new text begin (b) For purposes of this section, "consumer report," "consumer reporting agency," and
"medical information" have the meanings given them in the Fair Credit Reporting Act,
United States Code, title 15, section 1681a.
new text end

Sec. 9.

new text begin [332C.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Application. new text end

new text begin For purposes of this chapter, the following terms have the
meanings given.
new text end

new text begin Subd. 2. new text end

new text begin Collecting party. new text end

new text begin "Collecting party" means a party engaged in the collection
of medical debt for any account, bill, or other indebtedness, except as hereinafter provided.
new text end

new text begin Subd. 3. new text end

new text begin Debtor. new text end

new text begin "Debtor" means a person obligated or alleged to be obligated to pay
any debt.
new text end

new text begin Subd. 4. new text end

new text begin Medical debt. new text end

new text begin "Medical debt" means debt incurred primarily for necessary
medical care and related services.
new text end

new text begin Subd. 5. new text end

new text begin Person. new text end

new text begin "Person" means any individual, partnership, association, or corporation.
new text end

Sec. 10.

new text begin [332C.02] PROHIBITED PRACTICES.
new text end

new text begin No collecting party shall:
new text end

new text begin (1) in a collection letter, publication, invoice, or any oral or written communication,
threaten wage garnishment or legal suit by a particular lawyer, unless the collecting party
has actually retained the lawyer to do so;
new text end

new text begin (2) use or employ sheriffs or any other officer authorized to serve legal papers in
connection with the collection of a claim, except when performing their legally authorized
duties;
new text end

new text begin (3) use or threaten to use methods of collection which violate Minnesota law;
new text end

new text begin (4) furnish legal advice to debtors or represent that the collecting party is competent or
able to furnish legal advice to debtors;
new text end

new text begin (5) communicate with debtors in a misleading or deceptive manner by falsely using the
stationery of a lawyer, forms or instruments which only lawyers are authorized to prepare,
or instruments which simulate the form and appearance of judicial process;
new text end

new text begin (6) publish or cause to be published any list of debtors, use shame cards or shame
automobiles, advertise or threaten to advertise for sale any claim as a means of forcing
payment thereof, or use similar devices or methods of intimidation;
new text end

new text begin (7) operate under a name or in a manner which falsely implies the collecting party is a
branch of or associated with any department of federal, state, county, or local government
or an agency thereof;
new text end

new text begin (8) transact business or hold itself out as a debt settlement company, debt management
company, debt adjuster, or any person who settles, adjusts, prorates, pools, liquidates, or
pays the indebtedness of a debtor, unless there is no charge to the debtor, or the pooling or
liquidation is done pursuant to court order or under the supervision of a creditor's committee;
new text end

new text begin (9) unless an exemption in the law exists, violate Code of Federal Regulations, title 12,
part 1006, while attempting to collect on any account, bill, or other indebtedness. For
purposes of this section, Public Law 95-109 and Code of Federal Regulations, title 12, part
1006, apply to collecting parties;
new text end

new text begin (10) communicate with a debtor by use of an automatic telephone dialing system or an
artificial or prerecorded voice after the debtor expressly informs the collecting party to cease
communication utilizing an automatic telephone dialing system or an artificial or prerecorded
voice. For purposes of this clause, an automatic telephone dialing system or an artificial or
prerecorded voice includes but is not limited to (i) artificial intelligence chat bots, and (ii)
the usage of the term under the Telephone Consumer Protection Act, United States Code,
title 47, section 227(b)(1)(A);
new text end

new text begin (11) in collection letters or publications, or in any oral or written communication, imply
or suggest that medically necessary health treatment or services will be denied as a result
of a medical debt;
new text end

new text begin (12) when a debtor has a listed telephone number, enlist the aid of a neighbor or third
party to request that the debtor contact the collecting party, except a person who resides
with the debtor or a third party with whom the debtor has authorized with the collecting
party to place the request. This clause does not apply to a call back message left at the
debtor's place of employment which is limited solely to the collecting party's telephone
number and name;
new text end

new text begin (13) when attempting to collect a medical debt, fail to provide the debtor with the full
name of the collecting party, as registered with the secretary of state;
new text end

new text begin (14) fail to return any amount of overpayment from a debtor to the debtor or to the state
of Minnesota pursuant to the requirements of chapter 345;
new text end

new text begin (15) accept currency or coin as payment for a medical debt without issuing an original
receipt to the debtor and maintain a duplicate receipt in the debtor's payment records;
new text end

new text begin (16) attempt to collect any amount, including any interest, fee, charge, or expense
incidental to the charge-off obligation, from a debtor unless the amount is expressly
authorized by the agreement creating the medical debt or is otherwise permitted by law;
new text end

new text begin (17) falsify any documents with the intent to deceive;
new text end

new text begin (18) when initially contacting a Minnesota debtor by mail to collect a medical debt, fail
to include a disclosure on the contact notice, in a type size or font which is equal to or larger
than the largest other type of type size or font used in the text of the notice, that includes
and identifies the Office of the Minnesota Attorney General's general telephone number,
and states: "You have the right to hire your own attorney to represent you in this matter.";
new text end

new text begin (19) commence legal action to collect a medical debt outside the limitations period set
forth in section 541.053;
new text end

new text begin (20) report to a credit reporting agency any medical debt which the collecting party
knows or should know is or was originally owed to a health care provider, as defined in
section 62J.805, subdivision 2; or
new text end

new text begin (21) challenge a debtor's claim of exemption to garnishment or levy in a manner that is
baseless, frivolous, or otherwise in bad faith.
new text end

Sec. 11.

new text begin [332C.04] DEFENDING MEDICAL DEBT CASES.
new text end

new text begin A debtor who successfully defends against a claim for payment of medical debt that is
alleged by a collecting party must be awarded the debtor's costs, including a reasonable
attorney fee, incurred in defending against the collecting party's claim for debt payment.
new text end

Sec. 12.

new text begin [332C.06] ENFORCEMENT.
new text end

new text begin (a) The attorney general may enforce this chapter under section 8.31.
new text end

new text begin (b) A collecting party that violates this chapter is strictly liable to the debtor in question
for the sum of:
new text end

new text begin (1) actual damage sustained by the debtor as a result of the violation;
new text end

new text begin (2) additional damages as the court may allow, but not exceeding $1,000 per violation;
and
new text end

new text begin (3) in the case of any successful action to enforce the foregoing, the costs of the action,
together with a reasonable attorney fee as determined by the court.
new text end

new text begin (c) A collecting party that willfully and maliciously violates this chapter is strictly liable
to the debtor for three times the sums allowable under paragraph (b), clauses (1) and (2).
new text end

new text begin (d) The dollar amount limit under paragraph (b), clause (2), changes on July 1 of each
even-numbered year in an amount equal to changes made in the Consumer Price Index,
compiled by the United States Bureau of Labor Statistics. The Consumer Price Index for
December 2024 is the reference base index. If the Consumer Price Index is revised, the
percentage of change made under this section must be calculated on the basis of the revised
Consumer Price Index. If a Consumer Price Index revision changes the reference base index,
a revised reference base index must be determined by multiplying the reference base index
that is effective at the time by the rebasing factor furnished by the Bureau of Labor Statistics.
new text end

new text begin (e) If the Consumer Price Index is superseded, the Consumer Price Index referred to in
this section is the Consumer Price Index represented by the Bureau of Labor Statistics as
most accurately reflecting changes in the prices paid by consumers for consumer goods and
services.
new text end

new text begin (f) The attorney general must publish the base reference index under paragraph (c) in
the State Register no later than September 1, 2024. The attorney general must calculate and
then publish the revised Consumer Price Index under paragraph (c) in the State Register no
later than September 1 each even-numbered year.
new text end

new text begin (g) An action brought under this section benefits the public.
new text end

Sec. 13.

Minnesota Statutes 2022, section 334.01, is amended by adding a subdivision to
read:

new text begin Subd. 4. new text end

new text begin Contracts for medical care. new text end

new text begin Interest for any debt owed to a health care provider
incurred in exchange for care, treatment, services, devices, medicines, or procedures to
maintain, diagnose, or treat a person's physical or mental health shall be at a rate of $4 upon
$100 for a year.
new text end

Sec. 14.

Minnesota Statutes 2022, section 519.05, is amended to read:

519.05 LIABILITY OF deleted text begin HUSBAND AND WIFE deleted text end new text begin SPOUSES new text end .

(a) A spouse is not liable to a creditor for any debts of the other spouse. deleted text begin Where husband
and wife are living together, they shall be jointly and severally liable for necessary medical
services that have been furnished to either spouse, including any claims arising under section
246.53, 256B.15, 256D.16, or 261.04, and necessary household articles and supplies furnished
to and used by the family. deleted text end Notwithstanding this paragraph, in a proceeding under chapter
518 the court may apportion such debt between the spouses.

(b) Either spouse may close a credit card account or other unsecured consumer line of
credit on which both spouses are contractually liable, by giving written notice to the creditor.