4th Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am
1.1 A bill for an act 1.2 relating to insurance; regulating action plans of 1.3 certain health plan companies; requiring an 1.4 affirmative provider consent to participate in a 1.5 network under a category of coverage; requiring 1.6 disclosure of changes in a provider's contract; 1.7 imposing a moratorium on managed care auto insurance 1.8 plans; amending Minnesota Statutes 2000, sections 1.9 62Q.07; 62Q.74, subdivisions 2, 3, and 4; proposing 1.10 coding for new law in Minnesota Statutes, chapter 62Q. 1.11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.12 Section 1. Minnesota Statutes 2000, section 62Q.07, is 1.13 amended to read: 1.14 62Q.07 [ACTION PLANS.] 1.15 Subdivision 1. [ACTION PLANS REQUIRED.] (a) To increase 1.16 public awareness and accountability of health plan companies, 1.17 all health plan companies that issue or renew ahealth plan, as1.18defined in section 62Q.01managed care plan, as defined in 1.19 section 62U.01, must annually file with theapplicable1.20 commissioner an action plan that satisfies the requirements of 1.21 this section beginning July 1, 1994, as a condition of doing 1.22 business in Minnesota.For purposes of this subdivision,1.23"health plan" includes the coverages described in section1.2462A.011, subdivision 3, clause (10).Each health plan company 1.25 must also file its action plan with the information 1.26 clearinghouse. Action plans are required solely to provide 1.27 information to consumers, purchasers, and the larger community 1.28 as a first step toward greater accountability of health plan 2.1 companies. The sole function of the commissioner in relation to 2.2 the action plans is to ensure that each health plan company 2.3 files a complete action plan, that the action plan is truthful 2.4 and not misleading, and that the action plan is reviewed by 2.5 appropriate community agencies. 2.6 (b) Ifathe commissionerresponsible for regulating a2.7health plan company required to file an action plan under this2.8sectionhas reason to believe an action plan is false or 2.9 misleading, the commissioner may conduct an investigation to 2.10 determine whether the action plan is truthful and not 2.11 misleading, and may require the health plan company to submit 2.12 any information that the commissioner reasonably deems necessary 2.13 to complete the investigation. If the commissioner determines 2.14 that an action plan is false or misleading, the commissioner may 2.15 require the health plan company to file an amended plan or may 2.16 take any action authorized under chapter 72A. 2.17 Subd. 2. [CONTENTS OF ACTION PLANS.](a) An action plan2.18must include a detailed description of all of the health plan2.19company's methods and procedures, standards, qualifications,2.20criteria, and credentialing requirements for designating the2.21providers who are eligible to participate in the health plan2.22company's provider network, including any limitations on the2.23numbers of providers to be included in the network. This2.24description must be updated by the health plan company and filed2.25with the applicable agency on a quarterly basis.2.26(b) An action plan must include the number of full-time2.27equivalent physicians, by specialty, nonphysician providers, and2.28allied health providers used to provide services. The action2.29plan must also describe how the health plan company intends to2.30encourage the use of nonphysician providers, midlevel2.31practitioners, and allied health professionals, through at least2.32consumer education, physician education, and referral and2.33advisement systems. The annual action plan must also include2.34data that is broken down by type of provider, reflecting actual2.35utilization of midlevel practitioners and allied professionals2.36by enrollees of the health plan company during the previous3.1year. Until July 1, 1995, a health plan company may use3.2estimates if actual data is not available. For purposes of this3.3paragraph, "provider" has the meaning given in section 62J.03,3.4subdivision 8.3.5(c) An action plan must include a description of the health3.6plan company's policy on determining the number and the type of3.7providers that are necessary to deliver cost-effective health3.8care to its enrollees. The action plan must also include the3.9health plan company's strategy, including provider recruitment3.10and retention activities, for ensuring that sufficient providers3.11are available to its enrollees.3.12(d) An action plan must include a description of actions3.13taken or planned by the health plan company to ensure that3.14information from report cards, outcome studies, and complaints3.15is used internally to improve quality of the services provided3.16by the health plan company.3.17(e)An action plan must include a detailed description of 3.18 the health plan company's policies and procedures for enrolling 3.19 and serving high risk and special needs populations. This 3.20 description must also include the barriers that are present for 3.21 the high risk and special needs population and how the health 3.22 plan company is addressing these barriers in order to provide 3.23 greater access to these populations. "High risk and special 3.24 needs populations" includes, but is not limited to, recipients 3.25 of medical assistance, general assistance medical care, and 3.26 MinnesotaCare; persons with chronic conditions or disabilities; 3.27 individuals within certain racial, cultural, and ethnic 3.28 communities; individuals and families with low income; 3.29 adolescents; the elderly; individuals with limited or no English 3.30 language proficiency; persons with high-cost preexisting 3.31 conditions; homeless persons; chemically dependent persons; 3.32 persons with serious and persistent mental illness; children 3.33 with severe emotional disturbance; and persons who are at high 3.34 risk of requiring treatment. For purposes of this paragraph, 3.35 "provider" has the meaning given in section 62J.03, subdivision 3.36 8. 4.1(f) An action plan must include a general description of4.2any action the health plan company has taken and those it4.3intends to take to offer health coverage options to rural4.4communities and other communities not currently served by the4.5health plan company.4.6(g) A health plan company other than a large managed care4.7plan company may satisfy any of the requirements of the action4.8plan in paragraphs (a) to (f) by stating that it has no4.9policies, procedures, practices, or requirements, either written4.10or unwritten, or formal or informal, and has undertaken no4.11activities or plans on the issues required to be addressed in4.12the action plan, provided that the statement is truthful and not4.13misleading. For purposes of this paragraph, "large managed care4.14plan company" means a health maintenance organization or other4.15health plan company that employs or contracts with health care4.16providers, that has more than 50,000 enrollees in this state.4.17If a health plan company employs or contracts with providers for4.18some of its health plans and does not do so for other health4.19plans that it offers, the health plan company is a large managed4.20care plan company if it has more than 50,000 enrollees in this4.21state in health plans for which it does employ or contract with4.22providers.4.23 Sec. 2. Minnesota Statutes 2000, section 62Q.74, 4.24 subdivision 2, is amended to read: 4.25 Subd. 2. [PROVIDER CONSENT REQUIRED.] (a) No network 4.26 organization shall require a health care provider to participate 4.27 in a network under a category of coverage that differs from the 4.28 category or categories of coverage to which the existing 4.29 contract between the network organization and the provider 4.30 applies, without the affirmative consent of the provider 4.31 obtained under subdivision 3. 4.32 (b) This section does not apply to situations in which the 4.33 network organization wishes the provider to participate in a new 4.34 or different plan or other arrangement within a category of 4.35 coverage that is already provided for in an existing contract 4.36 between the network organization and the provider. 5.1 (c) Compliance with this section may not be waived in a 5.2 contract or otherwise. 5.3 Sec. 3. Minnesota Statutes 2000, section 62Q.74, 5.4 subdivision 3, is amended to read: 5.5 Subd. 3. [CONSENT PROCEDURE.] (a) The network 5.6 organization, if it wishes to apply an existing contract with a 5.7 provider to a different category of coverage, shall first notify 5.8 the provider in writing. The written notice must include at 5.9 least the following: 5.10 (1) the network organization's name, address, and telephone 5.11 number, and the name of the specific network, if it differs from 5.12 that of the network organization; 5.13 (2) a description of the proposed new category of coverage; 5.14 (3) the names of all payers expected by the network 5.15 organization to use the network for the new category of 5.16 coverage; 5.17 (4) the approximate number of current enrollees of the 5.18 network organization in that category of coverage within the 5.19 provider's geographical area; 5.20 (5) a disclosure of all contract terms of the proposed new 5.21 category of coverage, including the discount or reduced fees, 5.22 care guidelines, utilization review criteria, prior 5.23 authorization process, and dispute resolution process; 5.24 (6) a form for the provider's convenience in accepting or 5.25 declining participation in the proposed new category of 5.26 coverage, provided that the provider need not use that form in 5.27 responding; and 5.28 (7) a statement informing the provider of the provisions of 5.29 paragraph (b). 5.30 (b)If the provider does not decline participation within5.3130 days after the postmark date of the notice, the provider is5.32deemed to have accepted the proposed new category of5.33coverageUnless the provider has affirmatively agreed to 5.34 participate within 60 days after the postmark date of the 5.35 notice, the provider is deemed to have not accepted the proposed 5.36 new category of coverage. 6.1 Sec. 4. Minnesota Statutes 2000, section 62Q.74, 6.2 subdivision 4, is amended to read: 6.3 Subd. 4. [CONTRACT TERMINATION RESTRICTED.] (a) A network 6.4 organization must not terminate an existing contract with a 6.5 provider, or fail to honor the contract in good faith, based 6.6 solely on the provider's decision not to accept a proposed new 6.7 category of coverage. The most recent agreed-upon contractual 6.8 obligations remain in force until the existing contract's 6.9 renewal or termination date. 6.10 (b) If a provider declines to participate in a category of 6.11 coverage, the network organization must permit the provider the 6.12 opportunity to participate in that category of coverage when the 6.13 organization determines a demographic or geographic need. 6.14 Sec. 5. [62Q.745] [PROVIDER CONTRACT AMENDMENT 6.15 DISCLOSURE.] 6.16 (a) Any amendment or change in the terms of an existing 6.17 contract between a network organization and a health care 6.18 provider must be disclosed to the provider. 6.19 (b) Any amendment or change in the contract that alters the 6.20 financial reimbursement or alters the written contractual 6.21 policies and procedures governing the relationship between the 6.22 provider and the network organization must be disclosed to the 6.23 provider before the amendment or change is deemed to be in 6.24 effect. 6.25 (c) For purposes of this section, "network organization" 6.26 and "health care provider" or "provider" have the meanings given 6.27 in section 62Q.74. 6.28 Sec. 6. [62Q.746] [ACCESS TO CERTAIN INFORMATION REGARDING 6.29 PROVIDERS.] 6.30 Upon request of the commissioner, a health plan company 6.31 licensed under chapters 62C and 62D, must provide the following 6.32 information: 6.33 (1) a detailed description of the health plan company's 6.34 methods and procedures, standards, qualifications, criteria, and 6.35 credentialing requirements for designating the providers who are 6.36 eligible to participate in the health plan company's provider 7.1 network, including any limitations on the numbers of providers 7.2 to be included in the network; 7.3 (2) the number of full-time equivalent physicians, by 7.4 specialty, nonphysician providers, and allied health providers 7.5 used to provide services; and 7.6 (3) summary data that is broken down by type of provider, 7.7 reflecting actual utilization of network and non-network 7.8 practitioners and allied professionals by enrollees of the 7.9 health plan company. 7.10 Sec. 7. [MORATORIUM ON MANAGED CARE AUTOMOBILE INSURANCE 7.11 PLANS.] 7.12 (a) No health plan company as defined under Minnesota 7.13 Statutes, section 62Q.01, subdivision 4, or automobile insurance 7.14 company licensed under Minnesota Statutes, chapter 60A, may sign 7.15 any new no-fault automobile insurance managed care contract with 7.16 a health care provider between January 1, 2001, and June 30, 7.17 2002. A "managed care contract" is defined for purposes of this 7.18 section as a contract with a health care provider that provides 7.19 for prior authorization requirements, formulary limitations, 7.20 rate capitation, restricted protocols, or preestablished 7.21 limitations on the type, duration, or frequency of care. 7.22 (b) A health plan company that is party to a managed care 7.23 contract in existence prior to the moratorium created on January 7.24 1, 2001, must not, during the moratorium created under this act, 7.25 extend such a managed care contract to any additional insurers. 7.26 (c) This section is repealed effective June 30, 2002. 7.27 Sec. 8. [EFFECTIVE DATE.] 7.28 Section 7 is effective the day following final enactment.