HF 1652

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

  1.1                          A bill for an act
  1.2             relating to insurance; prohibiting certain 
  1.3             discriminatory charges; amending Minnesota Statutes 
  1.4             2002, section 72A.20, subdivision 33; proposing coding 
  1.5             for new law in Minnesota Statutes, chapters 62J; 62Q. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [62J.26] [UNIFORM CHARGES REQUIRED.] 
  1.8      (a) No health care provider, as defined in section 62J.03, 
  1.9   subdivision 8, shall vary its charges for health care goods and 
  1.10  services based upon the identity of the patient or of any 
  1.11  third-party payer. 
  1.12     (b) Variations in charges that are prohibited by paragraph 
  1.13  (a) include, but are not limited to, variations due to 
  1.14  capitation, preferred provider, exclusive provider, or other 
  1.15  contractual arrangements; variations due to the patient's 
  1.16  enrollment in Medicare, medical assistance, general assistance 
  1.17  medical care, MinnesotaCare, or other state or federal 
  1.18  government health coverage program; and variations due to 
  1.19  coverage under automobile, homeowner's, workers' compensation, 
  1.20  or other insurance. 
  1.21     (c) Charges based upon a capitation or similar arrangement 
  1.22  that is not based strictly on fee-for-service compensation 
  1.23  violate paragraph (a). 
  1.24     (d) This section does not prohibit providers from charging 
  1.25  reduced fees to family members, professional courtesy, 
  2.1   employees, or patients who are uninsured for the goods or 
  2.2   services provided and for whom, in the judgment of the provider, 
  2.3   payment of the provider's standard charge would be a financial 
  2.4   hardship. 
  2.5      (e) This section does not apply to an individual health 
  2.6   care provider who is salaried, but does apply to that provider's 
  2.7   employer. 
  2.8      (f) Each licensing board for health care providers shall 
  2.9   enforce this section with respect to the providers licensed by 
  2.10  the board. 
  2.11     (g) No public or private institutional third-party payer 
  2.12  for health care goods and services shall refuse to pay the 
  2.13  health care provider's uniform charge for health care goods and 
  2.14  services received from a health care provider in this state 
  2.15  solely because the provider complies with this section.  A 
  2.16  health care provider that encounters a violation of this 
  2.17  paragraph may report the violation to the attorney general.  The 
  2.18  attorney general shall enforce this paragraph under section 8.31.
  2.19     Sec. 2.  [62J.261] [PROVIDER CHARGES BASED UPON SIZE OF 
  2.20  PURCHASER PROHIBITED.] 
  2.21     No health care provider, as defined in section 62J.03, 
  2.22  subdivision 8, shall base its charges for health care services 
  2.23  upon the number of patients or enrollees for whose care the 
  2.24  provider is paid by a health plan company or other entity that 
  2.25  purchases or pays for health care services on a group basis.  
  2.26  This section includes situations in which the health plan 
  2.27  company or other group purchaser does not pay health care 
  2.28  providers directly and instead reimburses patients or enrollees 
  2.29  for payments they make to providers for health care services.  
  2.30  This section also applies to health care purchased or reimbursed 
  2.31  by insurers providing medical coverage under automobile, 
  2.32  homeowners, workers' compensation, or other types of insurance.  
  2.33  This section prohibits reduced charges by providers for care to 
  2.34  be provided through preferred provider organizations, exclusive 
  2.35  provider organizations, or similar arrangements. 
  2.36     Sec. 3.  [62Q.262] [HEALTH PLAN COMPANY CHARGES BASED UPON 
  3.1   SIZE OF PURCHASER PROHIBITED.] 
  3.2      (a) No health plan company shall base its premium rates, 
  3.3   enrollee charges, or similar fees for group coverage upon the 
  3.4   size of the private sector or public sector group purchaser or 
  3.5   upon the number of persons to be covered under the group 
  3.6   coverage.  This section prohibits discounts provided to 
  3.7   purchasing pools or to their members.  For purposes of this 
  3.8   section, group coverage includes individual coverage purchased 
  3.9   on a group basis.  This section does not apply to family 
  3.10  coverage unless it is purchased on a group basis by more than 
  3.11  one family.  This section does not prohibit compliance with 
  3.12  chapter 62L. 
  3.13     (b) This section does not prohibit discounts based upon 
  3.14  administrative cost savings to the health plan company as a 
  3.15  result of a written agreement between a health plan company and 
  3.16  a group purchaser, in which the purchaser agrees to perform, for 
  3.17  members of the group, services such as claims administration 
  3.18  that would normally be performed by the health plan company.  
  3.19  Any such services must be provided by human resources or 
  3.20  employee benefit professionals employed by or under contract 
  3.21  with the group purchaser.  Any such agreement must be filed with 
  3.22  the commissioner that regulates the health plan company and is 
  3.23  public data.  Performance of these agreements is subject to 
  3.24  random audit by the commissioner.  
  3.25     Sec. 4.  [62Q.263] [CAPITATION ARRANGEMENTS PROHIBITED.] 
  3.26     (a) No health plan company or other private sector or 
  3.27  public sector group purchaser of health care shall enter into or 
  3.28  perform an agreement to compensate health care providers on a 
  3.29  capitation or similar arrangement. 
  3.30     (b) No health care provider shall enter into or perform an 
  3.31  agreement described in paragraph (a).  
  3.32     Sec. 5.  Minnesota Statutes 2002, section 72A.20, 
  3.33  subdivision 33, is amended to read: 
  3.34     Subd. 33.  [PROHIBITION OF INAPPROPRIATE INCENTIVES.] No 
  3.35  insurer or health plan company may give any financial incentive 
  3.36  to a health care provider based solely on the number of services 
  4.1   denied or referrals not authorized by the provider.  This 
  4.2   subdivision does not prohibit capitation or other compensation 
  4.3   methods that serve to hold health care providers financially 
  4.4   accountable for the cost of caring for a patient population. 
  4.5      Sec. 6.  [EFFECTIVE DATE.] 
  4.6      Sections 1 to 5 are effective January 1, 2004, and apply to 
  4.7   contracts entered into or renewed on or after that date.