HF 1911

as introduced - 90th Legislature (2017 - 2018) Posted on 03/02/2017 12:51pm

A bill for an act
relating to health; prohibiting prepayment by a network provider; amending
Minnesota Statutes 2016, sections 62J.25; 62K.11.

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

Section 1.

Minnesota Statutes 2016, section 62J.25, is amended to read:

62J.25 MANDATORY MEDICARE ASSIGNMENT.

(a) Effective January 1, 1993, a health care provider shall not charge to or collect from
a Medicare beneficiary who is a Minnesota resident any amount in excess of 115 percent
of the Medicare-approved amount for any Medicare-covered service provided.

(b) Effective January 1, 1994, a health care provider shall not charge to or collect from
a Medicare beneficiary who is a Minnesota resident any amount in excess of 110 percent
of the Medicare-approved amount for any Medicare-covered service provided.

(c) Effective January 1, 1995, a health care provider shall not charge to or collect from
a Medicare beneficiary who is a Minnesota resident any amount in excess of 105 percent
of the Medicare-approved amount for any Medicare-covered service provided.

(d) Effective January 1, 1996, a health care provider shall not charge to or collect from
a Medicare beneficiary who is a Minnesota resident any amount in excess of the
Medicare-approved amount for any Medicare-covered service provided.

(e) This section does not apply to ambulance services as defined in section 144E.001,
subdivision 3, or medical supplies and equipment. A vendor of medical supplies and
equipment that does not accept assignment under the federal Medicare program with respect
to a purchase or lease of Medicare-covered supplies or equipment shall notify any purchaser
who is a Medicare beneficiary and Minnesota resident, prior to the purchase, or at any time
upon the request of the purchaser, that the vendor charges an amount in excess of the
Medicare-approved amount.

new text begin (f) Health carriers must include language in all network provider contracts prohibiting
providers from requiring prepayment for any amount covered by the health plan, and any
amount in excess of the allowable amount the health carrier has contracted for with the
provider as the total payment for the health care services.
new text end

Sec. 2.

Minnesota Statutes 2016, section 62K.11, is amended to read:

62K.11 BALANCE BILLING PROHIBITED.

(a) A network provider is prohibited from billing an enrollee for any amount in excess
of the allowable amount the health carrier has contracted for with the provider as total
payment for the health care service. A network provider is permitted to bill an enrollee the
approved co-payment, deductible, or coinsurance.

(b) A network provider is permitted to bill an enrollee for services not covered by the
enrollee's health plan as long as the enrollee agrees in writing in advance before the service
is performed to pay for the noncovered service.

new text begin (c) Health carriers must include language in all network provider contracts prohibiting
providers from requiring prepayment for any amount covered by the health plan, and any
amount in excess of the allowable amount the health carrier has contracted for with the
provider as the total payment for the health care services.
new text end