1.1                          A bill for an act 
  1.2             relating to health; establishing a minimum definition 
  1.3             of durable medical equipment; requiring disclosure of 
  1.4             covered medical equipment and supplies; proposing 
  1.5             coding for new law in Minnesota Statutes, chapter 62Q. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [62Q.66] [DURABLE MEDICAL EQUIPMENT COVERAGE.] 
  1.8      Subdivision 1.  [REQUIREMENT.] No health plan company that 
  1.9   covers durable medical equipment may utilize a definition of 
  1.10  durable medical equipment more restrictive than that in 
  1.11  subdivision 2 and may not limit durable medical equipment 
  1.12  coverage to equipment used in the home. 
  1.13     Subd. 2.  [MINIMUM DEFINITION.] "Durable medical equipment" 
  1.14  means a medically necessary personal item, piece of equipment, 
  1.15  or product system, whether modified or not, including necessary 
  1.16  repairs, that is suitable for repeated use and is:  
  1.17     (1) used to increase, maintain, or improve the functional 
  1.18  capabilities of a person; 
  1.19     (2) used to correct or accommodate a physiological 
  1.20  disability or physical condition of a person; 
  1.21     (3) is not more expensive than an appropriate alternative 
  1.22  which serves the same purpose; and 
  1.23     (4) is not primarily for educational, vocational, comfort, 
  1.24  convenience, or recreational purposes. 
  1.25     Sec. 2.  [62Q.67] [DISCLOSURE OF COVERED MEDICAL EQUIPMENT 
  2.1   AND SUPPLIES.] 
  2.2      Subdivision 1.  [DISCLOSURE.] A health plan company that 
  2.3   covers durable medical equipment or nondurable medical supplies 
  2.4   must include the following in the member contract or certificate 
  2.5   of coverage: 
  2.6      (1) a general description of the nature and level of 
  2.7   coverage available and the procedure for any required prior 
  2.8   authorizations; 
  2.9      (2) a summary of criteria used in making determinations as 
  2.10  to whether specific durable medical equipment or nondurable 
  2.11  medical supplies will be covered for individual enrollees; and 
  2.12     (3) the address and telephone number of a representative 
  2.13  whom an enrollee may contact to obtain a listing of commonly 
  2.14  covered durable medical equipment and nondurable medical 
  2.15  supplies, along with a detailed description of any limitations 
  2.16  or exclusions.  The listing must be provided to the enrollee 
  2.17  within 14 days of a request.  The information must also be 
  2.18  available prior to enrollment upon request. 
  2.19     Subd. 2.  [CERTAIN COVERAGE CHANGES PROHIBITED.] During a 
  2.20  contract period, a health plan company may not remove durable 
  2.21  medical equipment or nondurable medical supplies from coverage 
  2.22  or implement more restrictive criteria for coverage 
  2.23  determination. 
  2.24     Sec. 3.  [EFFECTIVE DATE; APPLICATION.] 
  2.25     Sections 1 and 2 are effective August 1, 1998, and apply to 
  2.26  health plans issued, renewed, or continued as defined in 
  2.27  Minnesota Statutes, section 60A.02, subdivision 2a, to provide 
  2.28  coverage to a Minnesota resident on or after that date.