HF 1554

as introduced - 90th Legislature (2017 - 2018) Posted on 02/27/2017 04:07pm

A bill for an act
relating to health care; requiring health plan companies to offer enrollees choice
in primary care providers; proposing coding for new law in Minnesota Statutes,
chapter 62Q; repealing Minnesota Statutes 2016, section 62Q.57.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.575] ACCESS TO PRIMARY CARE PROVIDERS.
new text end

new text begin Subdivision 1. new text end

new text begin Enrollee choice. new text end

new text begin No health plan company shall limit or restrict an
enrollee's ability to select or designate a primary care provider of the enrollee's choice if
the primary care provider has agreed to the terms of the health plan company's provider
contract.
new text end

new text begin Subd. 2. new text end

new text begin Provider network. new text end

new text begin (a) No health plan company shall deny a primary care
provider the right to participate in its provider in-network contracts if the following conditions
are met:
new text end

new text begin (1) the primary care provider has a valid license to practice the provider's profession in
this state; and
new text end

new text begin (2) the provider agrees to accept the terms and conditions offered by the health plan
company.
new text end

new text begin (b) A health plan company may require the primary care provider to meet reasonable
data requirements and utilization, review, and quality assurance requirements on the same
basis as others.
new text end

new text begin (c) The primary care provider must agree to serve all enrollees of the health care company
who choose the primary care provider.
new text end

new text begin Subd. 3. new text end

new text begin Cost-sharing or other conditions. new text end

new text begin (a) No health plan company shall impose
a co-payment, fee, or other cost-sharing requirement for selecting a primary care provider
of the enrollee's choosing or impose other conditions that limit or restrict an enrollee's ability
to utilize a primary care provider of the enrollee's choosing, unless the health plan company
imposes the same cost-sharing requirements, fees, conditions, or limits upon an enrollee's
selection of any of the primary care providers within the health plan company's provider
in-network contracts.
new text end

new text begin (b) A primary care provider may negotiate the payment rate for covered services provided
by the provider. This rate must be the same rate per unit of service as is paid to other
in-network primary care providers located within the same geographic area for the same or
similar services.
new text end

new text begin Subd. 4. new text end

new text begin Exclusions. new text end

new text begin (a) This section does not apply to enrollees who are enrolled in a
public health care program under chapter 256B or 256L.
new text end

new text begin (b) This section does not waive any exclusions of coverage under the terms and conditions
of the enrollee's health plan with respect to primary care coverage.
new text end

Sec. 2. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2016, section 62Q.57, new text end new text begin is repealed.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective January 1, 2018, and apply to any health plan issued or
renewed on or after that date.
new text end

APPENDIX

Repealed Minnesota Statutes: 17-2542

62Q.57 DESIGNATION OF PRIMARY CARE PROVIDER.

Subdivision 1.

Choice of primary care provider.

(a) If a health plan company offering a group health plan, or an individual health plan that is not a grandfathered plan, requires or provides for the designation by an enrollee of a participating primary care provider, the health plan company shall permit each enrollee to:

(1) designate any participating primary care provider available to accept the enrollee; and

(2) for a child, designate any participating physician who specializes in pediatrics as the child's primary care provider and is available to accept the child.

(b) This section does not waive any exclusions of coverage under the terms and conditions of the health plan with respect to coverage of pediatric care.

Subd. 2.

Notice.

A health plan company shall provide notice to enrollees of the provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act.

Subd. 3.

Enforcement.

The commissioner shall enforce this section.