1.1                          A bill for an act 
  1.2             relating to health; providing for certain mental 
  1.3             health coverage; prohibiting certain payment methods 
  1.4             for health maintenance organizations; amending 
  1.5             Minnesota Statutes 2000, section 62D.102; proposing 
  1.6             coding for new law in Minnesota Statutes, chapter 62D. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 2000, section 62D.102, is 
  1.9   amended to read: 
  1.10     62D.102 [FAMILY MENTAL HEALTH THERAPY.] 
  1.11     (a) In addition to any other minimum requirements 
  1.12  established by law, a group health maintenance contract 
  1.13  providing benefits for mental or nervous disorder treatments in 
  1.14  a hospital must also provide coverage for at least ten hours of 
  1.15  treatment over a 12-month period delivered while the enrollee is 
  1.16  not a bed patient in a hospital.  Prior authorization may be 
  1.17  required for an extension of coverage.  Prior authorization must 
  1.18  be based on the severity of the disorder, the patient's risk of 
  1.19  deterioration without ongoing treatment and maintenance, the 
  1.20  degree of functional impairment, and a concise treatment plan.  
  1.21     (b) Covered treatment for a minor includes treatment for 
  1.22  the family if family therapy is recommended by a health 
  1.23  maintenance organization provider.  
  1.24     (c) For purposes of determining benefits under this 
  1.25  section, "hours of treatment" means treatment rendered on an 
  1.26  individual or single-family basis.  If treatment is rendered on 
  2.1   a group basis, the hours of covered group treatment must be 
  2.2   provided at a ratio of no less than two group treatment sessions 
  2.3   to one individual treatment hour.  For a health maintenance 
  2.4   contract that is offered as a companion to a health insurance 
  2.5   subscriber contract, the benefits for mental or nervous 
  2.6   disorders must be calculated in aggregate for the health 
  2.7   maintenance contract and the health insurance subscriber 
  2.8   contract. 
  2.9      Sec. 2.  [62D.1025] [PROHIBITED HEALTH CARE PAYMENT 
  2.10  METHOD.] 
  2.11     Subdivision 1.  [DEFINITION.] For the purposes of this 
  2.12  section, "restricted annual rate" means any method of payment 
  2.13  that sets, as all or part of its payment scheme, a total payment 
  2.14  limit for any health care services for each person seeking 
  2.15  health care based on per person, per unit of time criteria that 
  2.16  disregard the extent of treatment or degree of services rendered.
  2.17     Subd. 2.  [PAYMENT METHOD PROHIBITED.] No health 
  2.18  maintenance organization shall compensate a provider of 
  2.19  outpatient services by using the restricted annual rate method 
  2.20  of payment. 
  2.21     Subd. 3.  [CONSTRUCTION.] This section shall not be 
  2.22  construed to prohibit or limit capitation or other risk-sharing 
  2.23  agreements between providers and insurers that are otherwise 
  2.24  permitted by law. 
  2.25     Sec. 3.  [EFFECTIVE DATE.] 
  2.26     Section 1 is effective the day following final enactment 
  2.27  and applies to all health maintenance contracts issued or 
  2.28  renewed to provide coverage to Minnesota residents on or after 
  2.29  that date.  Section 2 is effective January 1, 2002, and applies 
  2.30  to all health maintenance contracts issued or renewed to provide 
  2.31  coverage to Minnesota residents on or after that date.