HF 1148

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  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" means the following data on a 
  1.15  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; 
  1.22     (7) spouse's name; 
  1.23     (8) dependent's name; 
  1.24     (9) group number; 
  1.25     (10) policy number; and 
  2.1      (11) co-pay amount per category. 
  2.2      A covered individual's social security number shall be 
  2.3   included as eligibility data if the health plan company or group 
  2.4   purchaser uses it for enrollee identification or for enrollee 
  2.5   eligibility purposes. 
  2.6      (d) "Health plan company" has the meaning given in section 
  2.7   62Q.01, subdivision 4.  
  2.8      (e) "Patient" means a natural person who receives or is 
  2.9   about to receive services from a provider.  
  2.10     Subd. 2.  [DESIGNATION.] The commissioner shall establish a 
  2.11  process to designate business entities as qualified eligibility 
  2.12  clearinghouses.  Upon designation, a qualified eligibility 
  2.13  clearinghouse may provide eligibility data to health care 
  2.14  providers to facilitate access to this data. 
  2.15     Subd. 3.  [APPLICATION.] (a) To be designated by the 
  2.16  commissioner as a qualified eligibility clearinghouse, an entity 
  2.17  must provide the commissioner with:  
  2.18     (1) a description of procedures and safeguards to protect 
  2.19  the confidentiality and integrity of the data received; 
  2.20     (2) evidence indicating independence from provider or 
  2.21  health plan company ownership; and 
  2.22     (3) any other information requested by the commissioner.  
  2.23     (b) The commissioner may charge an application fee to each 
  2.24  applicant requesting designation.  The fee charged must not 
  2.25  exceed the cost incurred by the commissioner to process the 
  2.26  designation application.  
  2.27     Subd. 4.  [DATA COLLECTION.] A health plan company or group 
  2.28  purchaser must provide daily access to its database to a 
  2.29  qualified eligibility clearinghouse to collect eligibility data 
  2.30  on each covered individual eligible for health care benefits 
  2.31  through a policy, contract, certificate, evidence of coverage, 
  2.32  rider, binder, or endorsement offered by the health plan company 
  2.33  or group purchaser.  
  2.34     Subd. 5.  [RELEASE OF DATA.] (a) Upon the request of a 
  2.35  provider, a qualified eligibility clearinghouse must provide the 
  2.36  relevant eligibility data regarding a specific patient.  A 
  3.1   provider may only request eligibility data for a patient who has 
  3.2   authorized the provider to obtain eligibility data from the 
  3.3   patient's health plan company or group purchaser.  
  3.4      (b) The qualified eligibility clearinghouse may charge a 
  3.5   fee to the provider for providing eligibility data.  
  3.6      Subd. 6.  [DATA CLASSIFICATION.] (a) Data collected by a 
  3.7   qualified eligibility clearinghouse that identifies a covered 
  3.8   individual or patient are classified as private data on 
  3.9   individuals as defined under section 13.02, subdivision 12.  
  3.10  Data classified as private under this subdivision may be 
  3.11  released only as permitted under this section.  
  3.12     (b) Data received by a provider from a qualified 
  3.13  eligibility clearinghouse shall be considered part of a 
  3.14  patient's health record and shall be afforded all the protection 
  3.15  described in section 144.335.