1.1 	A bill for an act
1.2 	relating to health; requiring disclosures of certain
1.3 	payments; requiring disclosure of and limiting certain
1.4 	charges to the uninsured; limiting provider recourse;
1.5 	providing remedies; proposing coding for new law in
1.6 	Minnesota Statutes, chapter 62J.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. [62J.82] PROVIDER PAYMENT DISCLOSURE; CHARGES
1.9 	TO UNINSURED; PROVIDER RECOURSE.
1.10 		Subdivision 1.Definitions. (a) For purposes of this
1.11 	section, the terms defined in this subdivision have the meanings
1.12 	given them.
1.13 	(b) "Covered individual" means an individual who has health
1.14 	plan company or public health care program coverage for health
1.15 	care services.
1.16 	(c) "CPT code" means a code contained in the most current
1.17 	edition of the Physician's Current Procedural Terminology (CPT)
1.18 	manual published by the American Medical Association and
1.19 	available for purchase through the American Medical Association,
1.20 	Order Department:  OP054193, P.O. Box 10950, Chicago, Illinois
1.21 	60610.
1.22 	(d) "Dependent" has the meaning given under section 62L.02,
1.23 	subdivision 11.
1.24 	(e) "Health care service" has the meaning given under
1.25 	section 62J.17, subdivision 2.
1.26 	(f) "Health plan company" has the meaning given under
2.1 	section 62Q.01, subdivision 4.
2.2 	(g) "Person" means an individual, corporation, firm,
2.3 	partnership, incorporated or unincorporated association, or any
2.4 	other legal or commercial entity.
2.5 	(h) "Provider" has the meaning given under section 62J.03,
2.6 	subdivision 8.
2.7 	(i) "Third-party payer" means a health plan company or a
2.8 	public health care plan or program.
2.9 	(j) "Uninsured individual" means a person or dependent who
2.10 	does not have health plan company coverage or who is not
2.11 	otherwise covered by a third-party payer.
2.12 		Subd. 2.Provider payment disclosures. (a) A provider
2.13 	shall make available and, to the extent possible, immediately
2.14 	provide to any person who requests it, at no cost, the following
2.15 	information:
2.16 	(1) by CPT code, or other billing identifier as may be
2.17 	required to be used in billing for health care services, and
2.18 	narrative description, the amount the provider receives as
2.19 	payment for health care services from the federal Medicare
2.20 	program; and 
2.21 	(2) by CPT code, or other billing identifier as may be
2.22 	required to be used in billing for health care services, and
2.23 	narrative description, the amount the provider receives as
2.24 	payment for health care services from the medical assistance
2.25 	program administered by the commissioner of human services.
2.26 	(b) If a provider is unable to immediately provide the
2.27 	amount it receives as payment for health care services in
2.28 	response to a request made under this subdivision, the provider
2.29 	shall make available and provide the information to the person
2.30 	who requested it as soon as reasonably practicable, but in no
2.31 	event shall the time for disclosure be delayed by more than ten
2.32 	business days.
2.33 	(c) The information required under this subdivision shall
2.34 	be revised quarterly as necessary to reflect any changes to the
2.35 	amounts the provider receives under paragraph (a).
2.36 		Subd. 3.Notice to uninsured. (a) A provider may attempt
3.1 	to obtain from a person or the person's representative
3.2 	information about whether any third-party payer may fully or
3.3 	partially cover the charges for health care services rendered by
3.4 	the provider to the person.
3.5 	(b) A provider shall inform each person, both orally and in
3.6 	writing, immediately upon first meeting with that person, or as
3.7 	soon as practicable thereafter, that uninsured individuals will
3.8 	be charged or billed for health care services in amounts that do
3.9 	not exceed the amounts described in subdivision 4.
3.10 	(c) If, at the time health care services are provided, a
3.11 	person has not provided proof of coverage by a third-party payer
3.12 	or a provider otherwise determines that the person is an
3.13 	uninsured individual, the provider, as part of any billing to
3.14 	the person, shall provide the person with a clear and
3.15 	conspicuous notice that includes:
3.16 	(1) a statement of charges for health care services
3.17 	rendered by the provider;
3.18 	(2) for each of the health care services rendered by the
3.19 	provider, the amounts required to be disclosed under subdivision
3.20 	2; and 
3.21 	(3) a statement that uninsured individuals will be charged
3.22 	or billed for health care services in amounts that do not exceed
3.23 	the amounts described in subdivision 4.
3.24 	(d) For purposes of the notice required under paragraph
3.25 	(c), a provider may incorporate the items into the provider's
3.26 	existing billing statements and is not required to develop a
3.27 	separate notice.  All communications to a person required by
3.28 	this subdivision must be language appropriate.
3.29 		Subd. 4.Provider charges to uninsured. In billing or
3.30 	charging an uninsured individual or the individual's
3.31 	representative for health care services, a provider shall not
3.32 	bill or charge more than the higher of the Medicare or medical
3.33 	assistance payment required to be disclosed under subdivision 2
3.34 	at the time the bill or charge is issued, plus five percent.
3.35 	After a bill or charge is issued under this subdivision, a
3.36 	provider may not increase the bill or charge, even if the amount
4.1 	disclosed under subdivision 2 has increased.
4.2 		Subd. 5.Limitations. Notwithstanding any other
4.3 	provision of law, the amounts paid by uninsured individuals for
4.4 	health care services according to subdivision 4 does not
4.5 	constitute a provider's uniform, published, prevailing, or
4.6 	customary charges, or its usual fees to the general public, for
4.7 	purposes of any payment limit under the Medicare or medical
4.8 	assistance programs or any other federal or state financed
4.9 	health care program.
4.10 		Subd. 6.Recourse limited. (a) Providers under agreement
4.11 	with a health plan company or public health care plan or program
4.12 	to provide health care services shall not have recourse against
4.13 	covered individuals, or persons acting on their behalf, for
4.14 	amounts above those specified in the evidence of coverage or
4.15 	other plan or program document as co-payments or coinsurance for
4.16 	health care services.  This subdivision applies but is not
4.17 	limited to the following events:
4.18 	(1) nonpayment by the health plan company;
4.19 	(2) insolvency of the health plan company; and 
4.20 	(3) breach of the agreement between the health plan company
4.21 	and the provider.
4.22 	(b) This subdivision does not limit a provider's ability to
4.23 	seek payment from any person other than the covered individual,
4.24 	the covered individual's guardian or conservator, the covered
4.25 	individual's immediate family members, or the covered
4.26 	individual's legal representative in the event of nonpayment by
4.27 	a health plan company.
4.28 		Subd. 7.Remedies. A person may file an action in
4.29 	district court seeking injunctive relief and damages for
4.30 	violations of this section.  In any such action, a person may
4.31 	also recover costs and disbursements and reasonable attorney
4.32 	fees.
4.33 		Subd. 8.Grounds for disciplinary action. Violations of
4.34 	this section may be grounds for disciplinary or regulatory
4.35 	action against a provider by the appropriate licensing board or
4.36 	agency.
5.1 		Subd. 9.Authority of attorney general. The attorney
5.2 	general may investigate violations of this section under section
5.3 	8.31.  The attorney general may file an action for violations of
5.4 	this section according to section 8.31 or may pursue other
5.5 	remedies available to the attorney general.