HF 759

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; requiring providers to adopt 
  1.3             provider-specific uniform billing rates; proposing 
  1.4             coding for new law in Minnesota Statutes, chapter 62Q. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [62Q.42] [PROVIDER-SPECIFIC UNIFORM RATES.] 
  1.7      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.8   section, the following definitions apply. 
  1.9      (a) "Capitation" or "capitated payment arrangement" means a 
  1.10  method of payment for health services in which an individual or 
  1.11  institution is paid a fixed amount for each person served, 
  1.12  without regard to the actual number or nature of services 
  1.13  provided to each person in a set period of time. 
  1.14     (b) "Fee-for-service" or "fee-for-service payment 
  1.15  arrangement" means a method of payment for health care services 
  1.16  in which an individual or institution is paid separately for 
  1.17  each patient encounter or service rendered. 
  1.18     (c) "Group purchaser" means a person or organization that 
  1.19  purchases health care services on behalf of an identified group 
  1.20  of persons, regardless of whether the cost of coverage or 
  1.21  services is paid for by the purchaser or by the persons 
  1.22  receiving coverage or services.  Group purchaser includes, but 
  1.23  is not limited to, a health plan company, as defined in section 
  1.24  62Q.01, subdivision 4; the Minnesota comprehensive health 
  1.25  association; group health coverage offered by fraternal 
  2.1   organizations, professional associations, or other 
  2.2   organizations; state and federal health care programs; state and 
  2.3   local public employee health plans; workers' compensation plans; 
  2.4   and the medical component of automobile insurance coverage. 
  2.5      (d) "Health care provider" means an individual or 
  2.6   institution furnishing any or all of the following goods or 
  2.7   services directly to a patient or consumer:  medical, surgical, 
  2.8   optical, visual, dental, hearing, nursing services, drugs, 
  2.9   medical supplies, medical appliances, laboratory, diagnostic or 
  2.10  therapeutic services, or any goods and services not listed above 
  2.11  that qualify for reimbursement under the medical assistance 
  2.12  program established under chapter 256B. 
  2.13     Subd. 2.  [PROVIDER-SPECIFIC UNIFORM RATES REQUIRED.] Each 
  2.14  Minnesota health care provider shall adopt a provider-specific 
  2.15  uniform rate for all services.  This uniform rate must be either 
  2.16  a uniform fee schedule for all services or a uniform capitation 
  2.17  rate, or both if the provider is paid under both fee-for-service 
  2.18  and capitated payment arrangements.  Providers shall charge all 
  2.19  patients and group purchasers according to this uniform rate.  
  2.20  The amount that a provider charges a patient or group purchaser 
  2.21  may vary only with the type of service, and must be identical 
  2.22  for all payers.  Health care providers are prohibited from 
  2.23  agreeing to discount rates for a group purchaser, unless this 
  2.24  discounted rate applies to all other group purchasers and all 
  2.25  patients, as part of the uniform rate.  Health care providers 
  2.26  may discount rates for individual patients who do not have 
  2.27  health care coverage paid for by a group purchaser, without 
  2.28  applying this discounted rate to all other patients or to group 
  2.29  purchasers as part of a uniform rate.  This section does not 
  2.30  require all health care providers to adopt the same uniform 
  2.31  rate.  Uniform rates for the same service may be 
  2.32  provider-specific and uniform rates may vary across health care 
  2.33  providers. 
  2.34     Subd. 3.  [REIMBURSEMENT BY GROUP PURCHASERS.] Group 
  2.35  purchasers shall reimburse each health care provider at that 
  2.36  provider's uniform rate, minus any applicable enrollee 
  3.1   cost-sharing requirements, and may not require the provider to 
  3.2   provide a discount from the uniform rate. 
  3.3      Subd. 4.  [LIMITATIONS ON SCOPE.] This section does not 
  3.4   require a group purchaser to contract with or agree to reimburse 
  3.5   all health care providers.  This section does not require a 
  3.6   group purchaser to accept all providers into the group 
  3.7   purchaser's provider network. 
  3.8      Subd. 5.  [GOVERNMENT HEALTH PROGRAMS.] This section 
  3.9   applies to the MinnesotaCare and general assistance medical care 
  3.10  programs.  The commissioner of human services shall seek all 
  3.11  federal waivers, approvals, and law changes necessary to apply 
  3.12  the requirements of this section to the medical assistance and 
  3.13  Medicare programs. 
  3.14     Subd. 6.  [INFORMATION CLEARINGHOUSE.] Health care 
  3.15  providers shall file uniform rates with the information 
  3.16  clearinghouse established under section 62J.33, subdivision 2, 
  3.17  by January 1, 1996, and shall file all changes to uniform rates 
  3.18  quarterly. 
  3.19     Sec. 2.  [EFFECTIVE DATE.] 
  3.20     Section 1 is effective January 1, 1996, and applies to all 
  3.21  services furnished by health care providers on or after that 
  3.22  date.