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 an item, piece of equipment, or product system, whether 
  1.15  bought off the shelf, modified, or customized, that is suitable 
  1.16  for repeated use and is: 
  1.17     (i) used to increase, maintain, or improve the functional 
  1.18  capabilities of a person; or 
  1.19     (ii) used to correct or accommodate a physiological 
  1.20  disability or physical condition of a person.  
  1.21     Sec. 2.  [62Q.67] [DISCLOSURE OF COVERED MEDICAL EQUIPMENT 
  1.22  AND SUPPLIES.] 
  1.23     Subdivision 1.  [DISCLOSURE.] A health plan company that 
  1.24  covers durable medical equipment or nondurable medical supplies 
  1.25  must include the following in the member contract or certificate 
  2.1   of coverage: 
  2.2      (1) a general description of the nature and level of 
  2.3   coverage available and the procedure for any required prior 
  2.4   authorizations; 
  2.5      (2) a summary of criteria used in making determinations as 
  2.6   to whether specific durable medical equipment or nondurable 
  2.7   medical supplies will be covered for individual enrollees; and 
  2.8      (3) the address and telephone number of a representative 
  2.9   whom an enrollee may contact to obtain a listing of commonly 
  2.10  covered durable medical equipment and nondurable medical 
  2.11  supplies, along with a detailed description of any limitations 
  2.12  or exclusions.  The listing must be provided to the enrollee 
  2.13  within 14 days of a request.  The information must also be 
  2.14  available prior to enrollment upon request. 
  2.15     Subd. 2.  [CERTAIN COVERAGE CHANGES PROHIBITED.] (a) Except 
  2.16  as provided in paragraph (b), during a contract period, a health 
  2.17  plan company may not remove durable medical equipment or 
  2.18  nondurable medical supplies from coverage or implement more 
  2.19  restrictive criteria for coverage determination.  
  2.20     (b) A health plan company may remove durable medical 
  2.21  equipment or nondurable medical supplies from coverage if (1) 
  2.22  the durable medical equipment or nondurable medical supplies are 
  2.23  determined by an appropriate government agency to be unsafe or 
  2.24  hazardous, or (2) the durable medical equipment or nondurable 
  2.25  medical supplies are replaced by an improved product that serves 
  2.26  the same function, is of the same or higher quality, and results 
  2.27  in the same or nearly the same net cost to the consumer. 
  2.28     Sec. 3.  [EFFECTIVE DATE; APPLICATION.] 
  2.29     Sections 1 and 2 are effective August 1, 1998, and apply to 
  2.30  health plans issued, renewed, or continued as defined in 
  2.31  Minnesota Statutes, section 60A.02, subdivision 2a, to provide 
  2.32  coverage to a Minnesota resident on or after that date.