1.1                          A bill for an act 
  1.2             relating to health; establishing qualified eligibility 
  1.3             clearinghouses to provide eligibility data to health 
  1.4             care providers; proposing coding for new law in 
  1.5             Minnesota Statutes, chapter 62J.  
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [62J.62] [PROVIDER ACCESS TO ELIGIBILITY DATA.] 
  1.8      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
  1.9   section, the following definitions apply. 
  1.10     (b) "Covered individual" means a natural person who is 
  1.11  eligible to receive health care benefits under a policy, 
  1.12  contract, certificate, evidence of coverage, rider, binder, or 
  1.13  endorsement that provides for or describes health care coverage. 
  1.14     (c) "Eligibility data" is limited to the following data on 
  1.15  a covered individual:  
  1.16     (1) name; 
  1.17     (2) address; 
  1.18     (3) gender; 
  1.19     (4) age; 
  1.20     (5) date of birth; 
  1.21     (6) employer, if the individual has employer-sponsored 
  1.22  health coverage; 
  1.23     (7) spouse's name, if the spouse is covered by the policy; 
  1.24     (8) dependent's name, if covered by the policy; 
  1.25     (9) group number; 
  2.1      (10) policy number; 
  2.2      (11) individual identification number; 
  2.3      (12) start date and expiration date; 
  2.4      (13) inclusion of skilled nursing benefits, dental 
  2.5   benefits, or vision benefits; and 
  2.6      (14) co-pay amount per category. 
  2.7   No medical or health data may be collected.  Clauses (6), (7), 
  2.8   and (8) are not included in the definition of eligibility data 
  2.9   for individuals covered under the health care programs 
  2.10  administered by the department of human services.  
  2.11     (d) "Group purchaser" has the meaning given in section 
  2.12  62J.03, subdivision 6, and includes the department of human 
  2.13  services in its role as a purchaser in the medical assistance, 
  2.14  general assistance medical care, and MinnesotaCare programs. 
  2.15     (e) "Health plan company" has the meaning given in section 
  2.16  62Q.01, subdivision 4.  
  2.17     (f) "Patient" means a natural person who receives or is 
  2.18  about to receive services from a provider.  
  2.19     <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
  2.20  following final enactment. 
  2.21     Subd. 2.  [DESIGNATION.] (a) The commissioner shall 
  2.22  establish a process to designate business entities as qualified 
  2.23  eligibility clearinghouses.  Upon designation, a qualified 
  2.24  eligibility clearinghouse may provide eligibility data to health 
  2.25  care providers to facilitate access to this data. 
  2.26     (b) A qualified eligibility clearinghouse must not be owned 
  2.27  or operated by a health care provider, a health plan company, or 
  2.28  a group purchaser and the primary business of the clearinghouse 
  2.29  must be eligibility or claims data processing.  
  2.30     <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
  2.31  following final enactment. 
  2.32     Subd. 3.  [APPLICATION AND RENEWAL.] (a) To be designated 
  2.33  by the commissioner as a qualified eligibility clearinghouse, an 
  2.34  entity must provide the commissioner with:  
  2.35     (1) a description of procedures and safeguards to protect 
  2.36  the confidentiality and integrity of the data received, 
  3.1   including a description of the type of electronic transactions 
  3.2   to be utilized by the clearinghouse; 
  3.3      (2) evidence indicating independence from provider or 
  3.4   health plan company ownership; 
  3.5      (3) evidence indicating compliance with the Health 
  3.6   Insurance Portability and Accountability Act of 1996 privacy and 
  3.7   security provisions relating to the electronic exchange of 
  3.8   information and section 144.335; and 
  3.9      (4) any other information requested by the commissioner.  
  3.10     (b) The designation as a qualified eligibility 
  3.11  clearinghouse shall be valid for a two-year period from the date 
  3.12  of designation.  Before the expiration of the two-year period, 
  3.13  the commissioner shall review the designation to determine 
  3.14  whether the eligibility clearinghouse continues to meet the 
  3.15  criteria established under this section.  The commissioner may 
  3.16  require the eligibility clearinghouse whose designation is being 
  3.17  reviewed to submit to the commissioner an application for 
  3.18  renewal and may request the submission of any information deemed 
  3.19  necessary by the commissioner to determine whether the 
  3.20  eligibility clearinghouse is in compliance with this section.  
  3.21  Based on the review, the commissioner may renew the eligibility 
  3.22  clearinghouse's designation as a qualified eligibility 
  3.23  clearinghouse for a two-year period.  
  3.24     (c) The commissioner may charge an application and renewal 
  3.25  fee to each applicant requesting designation or for designation 
  3.26  renewal.  The fee charged must not exceed the administrative 
  3.27  cost of processing the designation application or designation 
  3.28  renewal.  
  3.29     <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
  3.30  following final enactment. 
  3.31     Subd. 4.  [DATA COLLECTION.] (a) A health plan company or 
  3.32  group purchaser must provide immediate and secure access to its 
  3.33  eligibility information database to a qualified eligibility 
  3.34  clearinghouse to determine eligibility data for each covered 
  3.35  individual eligible for health care benefits through a policy, 
  3.36  contract, certificate, evidence of coverage, rider, binder, or 
  4.1   endorsement offered by the health plan company or group 
  4.2   purchaser.  The technology used to provide access must comply 
  4.3   with the Health Insurance Portability and Accountability Act of 
  4.4   1996 security provisions relating to the electronic exchange of 
  4.5   information.  
  4.6      (b) A health plan company or group purchaser must not 
  4.7   charge a fee to a qualified eligibility clearinghouse for 
  4.8   providing access to its eligibility information database.  This 
  4.9   paragraph does not apply to the department of human services.  
  4.10     <b>[EFFECTIVE DATE.]</b> This subdivision is effective January 1, 
  4.11  2004. 
  4.12     Subd. 5.  [RELEASE OF DATA.] (a) Upon the request of a 
  4.13  provider, a qualified eligibility clearinghouse must provide the 
  4.14  relevant eligibility data regarding a specific patient.  A 
  4.15  provider may only request eligibility data for a patient who has 
  4.16  authorized the provider to obtain eligibility data from the 
  4.17  patient's health plan company or group purchaser.  
  4.18     (b) The qualified eligibility clearinghouse may charge a 
  4.19  fee to the provider for providing eligibility data.  
  4.20     <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
  4.21  following final enactment. 
  4.22     Subd. 6.  [PRIVACY OF DATA.] (a) Data collected or received 
  4.23  by a qualified eligibility clearinghouse that identify or can be 
  4.24  used to identify a covered individual or patient may be used and 
  4.25  released only for purposes of subdivision 5.  Upon request and 
  4.26  appropriate verification of identity, the data must be released 
  4.27  to the subject of the data.  Further use or release of the data 
  4.28  is prohibited.  A qualified eligibility clearinghouse that uses 
  4.29  or releases data in violation of this paragraph is liable to the 
  4.30  subject of the data for damages plus costs and reasonable 
  4.31  attorney fees. 
  4.32     (b) Data collected or received by a provider from a 
  4.33  qualified eligibility clearinghouse are considered part of a 
  4.34  patient's health record for purposes of section 144.335. 
  4.35     (c) Data collected or received by a qualified eligibility 
  4.36  clearinghouse or by a provider under this section must be 
  5.1   exchanged and maintained in compliance with the federal Health 
  5.2   Insurance Portability and Accountability Act of 1996 and 
  5.3   regulations adopted under that act. 
  5.4      <b>[EFFECTIVE DATE.]</b> This subdivision is effective the day 
  5.5   following final enactment.