HF 2372

as introduced - 89th Legislature (2015 - 2016) Posted on 05/18/2015 10:55am

A bill for an act
relating to health; establishing the Healthcare Access for Recovery and Treatment
of Survivors Act (HARTS Act); requiring health insurance coverage for certain
coverage relating to domestic and sexual assault and sex trafficking; requiring
certain notice be provided to victims; appropriating money; amending Minnesota
Statutes 2014, sections 144.6586; 145.4712, subdivision 2; 609.35; 629.341,
subdivision 3; proposing coding for new law in Minnesota Statutes, chapter 62A;
proposing coding for new law as Minnesota Statutes, chapter 62W.

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

Section 1.

new text begin [62A.3095] COVERAGE FOR CARE RELATING TO DOMESTIC
AND SEXUAL ASSAULT AND SEX TRAFFICKING.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin This section applies to all health plans as defined
in section 62A.011 that provide coverage to a Minnesota resident.
new text end

new text begin Subd. 2. new text end

new text begin Required coverage. new text end

new text begin Every health plan included in subdivision 1 must
cover medically necessary treatment for victims of domestic or sexual assault and sex
trafficking for care needed as a result of the assault. For purposes of this section, domestic
assault, sexual assault, and sex trafficking have the meanings given in section 62W.02. No
health carrier may reduce or eliminate coverage due to this requirement nor subject an
enrollee to any cost sharing or deductible for this requirement.
new text end

new text begin Subd. 3. new text end

new text begin Prescription medication. new text end

new text begin Any health plan included under subdivision
1 that covers prescription medication must cover the cost of medication prescribed for
care as a result of domestic or sexual assault or sex trafficking. Prescription medication
prescribed for care as a result of the assault must not be subject to any cost sharing or
deductible for the enrollee.
new text end

new text begin Subd. 4. new text end

new text begin Rate increases prohibited. new text end

new text begin The commissioner of commerce shall not
approve any rate increases due to coverage required under subdivision 2 or 3. No health
maintenance organization, as defined in chapter 62D, shall increase rates due to coverage
required under subdivision 2 or 3.
new text end

Sec. 2.

new text begin [62W.01] TITLE AND PURPOSE.
new text end

new text begin Subdivision 1. new text end

new text begin Title. new text end

new text begin This chapter may be cited as the "Healthcare Access for
Recovery and Treatment of Survivors Act" or the "HARTS Act."
new text end

new text begin Subd. 2. new text end

new text begin Purpose. new text end

new text begin (a) The legislature finds that the health care needs of victims
of domestic and sexual assault and sex trafficking are unique to health care needs of the
general population and recognizes that these victims, regardless of insurance coverage,
often do not seek medical care due to a variety of factors, including, but not limited to,
fear of future abuse by an abuser who is known to the victim and may have access to the
victim's health insurance information. The legislature also finds that untreated physical
and mental injuries as a result of domestic and sexual assault and sex trafficking results
in billions of dollars of costs each year to the health care system nationwide and, that
by victims not filing insurance claims for health care, both the state and private health
carriers experience initial reduced costs as a result of not having claims submitted. In
order to support victims' safety, provide adequate care to victims, and support a victim's
physical and mental recovery after experiencing abuse, the legislature finds it necessary
to provide a way for victims of domestic and sexual assault and sex trafficking to obtain
health care while maintaining anonymity.
new text end

new text begin (b) As a result of utilizing the initial cost savings of the state and private health
carriers resulting from unsubmitted claims related to domestic and sexual assault and sex
trafficking, and by providing victims with a safe and anonymous way to obtain medical
care, the legislature finds that as a result of timely, comprehensive, and safe medical care
being provided to these victims, their health will be improved and a future cost reduction
for the overall health care system is likely.
new text end

Sec. 3.

new text begin [62W.02] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Applicability. new text end

new text begin The following definitions shall apply to this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the commissioner of health.
new text end

new text begin Subd. 3. new text end

new text begin Domestic assault. new text end

new text begin "Domestic assault" means any of the following acts, if
alleged to have been perpetrated by a family or household member as defined in section
518B.01, subdivision 2, paragraph (b):
new text end

new text begin (1) first-degree assault, as defined in section 609.221;
new text end

new text begin (2) second-degree assault, as defined in section 609.222;
new text end

new text begin (3) third-degree assault, as defined in section 609.223;
new text end

new text begin (4) domestic assault, as defined in section 609.2242;
new text end

new text begin (5) female genital mutilation, as defined in section 609.2245;
new text end

new text begin (6) domestic assault by strangulation, as defined in section 609.2247;
new text end

new text begin (7) terroristic threats, as defined in section 609.713;
new text end

new text begin (8) stalking, as defined in section 609.749;
new text end

new text begin (9) violation of an order for protection, as defined in section 518B.01, subdivision 14;
new text end

new text begin (10) violation of a harassment restraining order, as defined in section 609.748,
subdivision 6; or
new text end

new text begin (11) violation of a domestic abuse no contact order, as defined in section 629.75.
new text end

new text begin Subd. 4. new text end

new text begin Health care for domestic and sexual violence and sex trafficking
victims account. new text end

new text begin "Health care for domestic and sexual violence and sex trafficking
victims account" or "account" means the account established in section 62W.04.
new text end

new text begin Subd. 5. new text end

new text begin Health care provider. new text end

new text begin "Health care provider" means hospitals licensed
under chapter 144 and any health care practitioner regulated by a health-related licensing
board, as defined in section 214.01, subdivision 2, excluding the Board of Examiners of
Nursing Home Administrators and the Board of Veterinary Medicine.
new text end

new text begin Subd. 6. new text end

new text begin Health carrier. new text end

new text begin "Health carrier" means a health carrier as defined in section
62A.011, subdivision 2, and the commissioner of human services, in the commissioner's
capacity as the provider of state-sponsored health care plans.
new text end

new text begin Subd. 7. new text end

new text begin Health plan. new text end

new text begin "Health plan" means a health plan as defined in section
62A.011, subdivision 3, and plans offered to enrollees of a state-sponsored health care plan.
new text end

new text begin Subd. 8. new text end

new text begin Medically necessary care. new text end

new text begin "Medically necessary care" means, at a
minimum, medically necessary care as defined in section 62Q.53, subdivision 2.
new text end

new text begin Subd. 9. new text end

new text begin Sex trafficking. new text end

new text begin "Sex trafficking" means any of the acts defined in section
609.321, subdivision 7a, regardless of the relationship between the victim and the alleged
perpetrator of the act.
new text end

new text begin Subd. 10. new text end

new text begin Sexual assault. new text end

new text begin "Sexual assault" means any of the following acts,
regardless of the relationship between the victim and the alleged perpetrator of the act:
new text end

new text begin (1) first-degree criminal sexual conduct, as defined in section 609.342;
new text end

new text begin (2) second-degree criminal sexual conduct, as defined in section 609.343;
new text end

new text begin (3) third-degree criminal sexual conduct, as defined in section 609.344;
new text end

new text begin (4) fourth-degree criminal sexual conduct, as defined in section 609.345;
new text end

new text begin (5) fifth-degree criminal sexual conduct, as defined in section 609.3451; or
new text end

new text begin (6) criminal sexual predatory conduct, as defined in section 609.3453.
new text end

new text begin Subd. 11. new text end

new text begin State-sponsored health care plan. new text end

new text begin "State-sponsored health care
plan" means medical assistance fee-for-service coverage and medical assistance or
MinnesotaCare coverage provided through managed care or county-based purchasing
plans under section 256B.69 or 256B.692.
new text end

new text begin Subd. 12. new text end

new text begin Victim. new text end

new text begin "Victim" means a person who alleges or is alleged to have
been domestically or sexually assaulted or sex trafficked, and who presents to a health
care provider as a patient. For purposes of receiving mental health care and treatment,
victim also includes the minor child of a person who alleges, or is alleged to have been,
domestically or sexually assaulted or sex trafficked.
new text end

Sec. 4.

new text begin [62W.03] STANDARDIZED FEES.
new text end

new text begin (a) The commissioner of human services shall establish a work group for the
purposes of standardizing fees for the treatments listed under paragraph (b) that are
charged by health care providers to health carriers for costs associated with domestic and
sexual assault and sex trafficking. The work group shall include, at a minimum:
new text end

new text begin (1) the commissioner of health or a designee;
new text end

new text begin (2) the commissioner of commerce or a designee;
new text end

new text begin (3) representatives of health carriers that provide health plans to Minnesota
residents; and
new text end

new text begin (4) representatives of health care providers.
new text end

new text begin (b) The work group shall convene in order to make recommendations to the
commissioner of human services for amounts to be charged by health care providers for
treatment of a victim of domestic or sexual assault or sex trafficking for care needed as a
result of the assault, including:
new text end

new text begin (1) emergency examinations of sexual assault victims, as provided in section 609.35;
new text end

new text begin (2) emergency contraceptives;
new text end

new text begin (3) medication prescribed to reduce the chances of contracting or to eliminate
sexually transmitted diseases;
new text end

new text begin (4) medication prescribed to treat pain or risk of infection for physical injuries;
new text end

new text begin (5) emergency mental health assessments; and
new text end

new text begin (6) medication prescribed for mental health treatment.
new text end

new text begin (c) The commissioner of human services shall convene the work group by August 1,
2016. The commissioner of human services, after consultation with the work group, shall
establish standardized fees for care included in paragraph (b) by January 1, 2016.
new text end

Sec. 5.

new text begin [62W.04] UNCOMPENSATED COSTS; ACCOUNT.
new text end

new text begin Subdivision 1. new text end

new text begin Establishment. new text end

new text begin The commissioner shall maintain a Healthcare
Access for Recovery and Treatment of Survivors (HARTS) account for the purposes of
providing grants to health care providers for uncompensated costs relating to medically
necessary care provided to victims of domestic or sexual assault or sex trafficking. The
HARTS account shall be funded and managed in accordance with this section.
new text end

new text begin Subd. 2. new text end

new text begin Funding. new text end

new text begin (a) Every health carrier that enrolls a Minnesota resident in a
health plan shall annually pay $4.50 per enrollee to the commissioner. All funds received
by the commissioner from a health carrier shall be directly deposited into the HARTS
account. Funds shall be collected by the commissioner on an annual basis.
new text end

new text begin (b) The cost under paragraph (a) for enrollees in a state-sponsored health care
program shall be paid by the commissioner of human services.
new text end

new text begin (c) The commissioner shall assess the need and use of the HARTS account on a yearly
basis in order to evaluate the per-enrollee assessment that will be charged to health carriers.
The commissioner shall report the need of any change in the per-enrollee share, whether it
be a reduction or an increase, to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services by January 15 of each year.
new text end

new text begin (d) Self-insured employers may choose to pay a per-enrollee contribution into the
HARTS account on an annual basis. Any self-insured employer that chooses to pay this
cost shall pay a contribution equal to the assessment under paragraph (a) and shall pay for
all employees enrolled in the self-insured employer's plan.
new text end

new text begin (e) The commissioner of commerce shall not approve any premium rate increases
as a result of either the mandatory or voluntary payments to the HARTS account under
this subdivision.
new text end

new text begin Subd. 3. new text end

new text begin Appropriation. new text end

new text begin Any funds collected by the commissioner and deposited
in the HARTS account is appropriated to the commissioner for use in implementing this
chapter. No more than one percent of the total of the HARTS account upon the collection
of enrollee fees may be used by the commissioner for administrative purposes.
new text end

Sec. 6.

new text begin [62W.05] REIMBURSEMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Commissioner duties. new text end

new text begin (a) The commissioner shall reimburse any
health care provider for uncompensated costs under the HARTS account who submits the
forms created by the commissioner under paragraphs (b) and (c).
new text end

new text begin (b) The commissioner shall establish a standardized form for use by a health care
provider to seek reimbursement. The form must not include the victim's name or any
other unique identifying information about the victim. The form must include, but is not
limited to, spaces for the provider to state:
new text end

new text begin (1) the care provided to the victim;
new text end

new text begin (2) the cost of the care provided to the victim;
new text end

new text begin (3) a unique identifying code for an individual victim;
new text end

new text begin (4) the date, time, and location of the services provided to the victim;
new text end

new text begin (5) whether the alleged assault was a sexual assault, domestic assault, sex trafficking,
or a combination; and
new text end

new text begin (6) any other information the commissioner needs in order to process the
reimbursement request.
new text end

new text begin (c) The commissioner shall also create a standardized form to be distributed to all
health care providers to be filled out either by the victim or by a health care provider on
behalf of the victim based on information told to the provider by the victim. The form
must not include the victim's name or any other unique identifying information about the
victim. The form must include:
new text end

new text begin (1) whether or not law enforcement was contacted;
new text end

new text begin (2) the gender of the victim;
new text end

new text begin (3) the age of the victim;
new text end

new text begin (4) whether or not the victim has health insurance; and
new text end

new text begin (5) whether the alleged perpetrator was known to the victim prior to the assault.
new text end

new text begin (d) The standardized forms developed by the commissioner under paragraphs (b)
and (c) may be on the same form, as long as the health care provider allows the victim the
option of filling out the information required under paragraph (c).
new text end

new text begin Subd. 2. new text end

new text begin Health care provider duties. new text end

new text begin (a) A health care provider must inform any
victim who alleges physical or mental injury as a result of a domestic or sexual assault or
sex trafficking of the victim's right to anonymous coverage for the costs of the victim's
medically necessary needs, regardless of whether or not the victim has health insurance.
The health care provider must determine, based on information provided by the victim,
whether or not the victim has alleged a domestic or sexual assault or sex trafficking as
defined in section 62W.02. The health care provider may, with the victim's permission,
work with a victim advocacy agency or other staff in order to determine whether the
victim has alleged a domestic or sexual assault or sex trafficking.
new text end

new text begin (b) A health care provider shall inform the victim, orally and in writing, that the
victim may use private insurance or state-sponsored health care program insurance to
cover the cost of the care.
new text end

new text begin (c) If a victim chooses not to use private insurance or state-sponsored health care
coverage, regardless of whether the victim is enrolled in coverage, a health care provider
shall inform the victim, orally and in writing, that:
new text end

new text begin (1) no identifying information about the victim will be transmitted to the
commissioner;
new text end

new text begin (2) costs must be reimbursed regardless of whether or not law enforcement has
been contacted about the alleged assault;
new text end

new text begin (3) no mail, phone calls, or other communication shall come from the commissioner;
new text end

new text begin (4) the victim's medical information shall only be released by the commissioner as
part of an audit as allowed under section 62W.06 and shall not include any identifying
information about the victim; and
new text end

new text begin (5) costs shall be compensated only if the health care provider and the victim
provide the information required under subdivision 1. If a victim refuses to give the
information required under subdivision 1, the costs of the care shall not be compensated
through the HARTS account.
new text end

new text begin (d) In order to seek reimbursement for care associated with a victim's domestic or
sexual assault or sex trafficking, a health care provider must submit both forms described
in subdivision 1 to the commissioner of health.
new text end

new text begin (e) Any health care provider that seeks reimbursement under this chapter shall
keep records for all victims for whom reimbursement was sought. Records shall be
kept with a unique identifying code for the individual victim and shall not contain any
individually identifiable information, including, but not limited to, the victim's name
or address. Upon request by the commissioner for an audit of records as provided in
section 62W.06, subdivision 1, a health care provider must provide only those records
kept according to this paragraph.
new text end

new text begin Subd. 3. new text end

new text begin Emergency examinations for sexual assault victims. new text end

new text begin Nothing in this
chapter shall be construed to negate or otherwise change a county's obligation to pay the
costs incurred for the examination of a victim under section 609.35.
new text end

new text begin Subd. 4. new text end

new text begin Data privacy. new text end

new text begin All data submitted to the commissioner by a health care
provider are private data on individuals as defined in section 13.02, subdivision 12. All
health records must be kept in accordance with applicable federal and state law.
new text end

Sec. 7.

new text begin [62W.06] COMMISSIONER'S DUTIES.
new text end

new text begin Subdivision 1. new text end

new text begin Audits. new text end

new text begin The commissioner may audit the health care providers that
have received reimbursement under this chapter. The commissioner shall not access a
victim's identifiable information and shall only access the records of the victim through the
unique identifying code kept by the health care provider, as required in section 62W.05,
subdivision 2, paragraph (e). The commissioner shall provide written notice to a health
care provider prior to conducting an audit.
new text end

new text begin Subd. 2. new text end

new text begin Reports. new text end

new text begin The commissioner shall report publicly on the department's Web
site and to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services and commerce the following reports:
new text end

new text begin (1) annually, beginning January 15, 2016, a report of summary data collected
from health care providers on all information collected on the forms outlined in section
62W.05, subdivision 1;
new text end

new text begin (2) annually, beginning January 15, 2017, the total amount submitted to the HARTS
account by health carriers and self-insured employers and the total amount expended from
the HARTS account for reimbursement to a health care provider; and
new text end

new text begin (3) annually, beginning January 15, 2016, a report on all self-insured companies that
chose to pay the per-enrollee fee under section 62W.04, subdivision 2, paragraph (c), and a
list of self-insured companies that chose not to pay the per-enrollee fee. The commissioner
may consult with the commissioner of commerce in order to prepare this report.
new text end

Sec. 8.

Minnesota Statutes 2014, section 144.6586, is amended to read:

144.6586 NOTICE OF RIGHTS TO SEXUAL new text begin OR DOMESTIC new text end ASSAULT new text begin OR
SEX TRAFFICKING new text end VICTIM.

Subdivision 1.

Notice required.

A hospital shall give a new text begin verbal and new text end written notice
about victim rights and available resources to a person seeking medical services in the
hospital who reports to hospital staff or presents evidence of a sexual new text begin or domestic new text end assault
or other unwanted sexual contact or sexual penetration new text begin , including, but not limited to,
those that are a result of sex trafficking new text end . The hospital shall make a good faith effort to
provide this notice prior to medical treatment or the examination performed for the
purpose of gathering evidence, subject to applicable federal and state laws and regulations
regarding the provision of medical care, and in a manner that does not interfere with any
medical screening examination or initiation of treatment necessary to stabilize a victim's
emergency medical condition.

Subd. 2.

Contents of notice.

The commissioners of health and public safety, in
consultation with sexual new text begin and domestic new text end assault new text begin and sex trafficking new text end victim advocates and
health care professionals, shall develop the notice required by subdivision 1. The notice
must inform the victim, at a minimum, of:

(1) the obligation under section 609.35 of the county where the criminal sexual
conduct occurred to pay for the examination performed for the purpose of gathering
evidence, that payment is not contingent on the victim reporting the criminal sexual conduct
to law enforcement, and that the victim may incur expenses for treatment of injuries; deleted text begin and
deleted text end

(2) the victim's rights if the crime is reported to law enforcement, including the
victim's right to apply for reparations under sections 611A.51 to 611A.68, information on
how to apply for reparations, and information on how to obtain an order for protection or a
harassment restraining order new text begin ; and
new text end

new text begin (3) the victim's right to receive medically necessary care at no cost to the victim, as
provided in chapter 62W new text end .

Sec. 9.

Minnesota Statutes 2014, section 145.4712, subdivision 2, is amended to read:

Subd. 2.

Emergency care to male and female sexual assault victims.

It shall be
the standard of care for all hospitals that provide emergency care to, at a minimum:

(1) provide each sexual assault victim with factually accurate and unbiased written
and oral medical information about prophylactic antibiotics for treatment of sexually
transmitted diseases;

(2) orally inform each sexual assault victim of the option of being provided
prophylactic antibiotics for treatment of sexually transmitted diseases at the hospital; deleted text begin and
deleted text end

(3) immediately provide prophylactic antibiotics for treatment of sexually
transmitted diseases to each sexual assault victim who requests it, provided it is not
medically contraindicated and is ordered by a legal prescriber new text begin ;
new text end

new text begin (4) provide each sexual assault victim with medically necessary care for any injury
attributable to the assault; and
new text end

new text begin (5) orally, and in writing, inform the victim of the victim's ability to receive
medically necessary care at no cost to the victim, as provided in chapter 62W new text end .

Sec. 10.

Minnesota Statutes 2014, section 609.35, is amended to read:

609.35 COSTS OF MEDICAL EXAMINATION.

(a) Costs incurred by a county, city, or private hospital or other emergency medical
facility or by a private physician for the examination of a victim of criminal sexual
conduct when the examination is performed for the purpose of gathering evidence shall be
paid by the county in which the criminal sexual conduct occurred. These costs include,
but are not limited to, full cost of the rape kit examination, associated tests relating to the
complainant's sexually transmitted disease status, and pregnancy status.

(b) Nothing in this section shall be construed to limit the duties, responsibilities,
or liabilities of any insurer, whether public or private. However, a county may seek
insurance reimbursement from the victim's insurer only if authorized by the victim. This
authorization may only be sought after the examination is performed. When seeking this
authorization, the county shall inform the victim that if the victim does not authorize this,
the county is required by law to pay for the examination and that the victim is in no way
liable for these costs or obligated to authorize the reimbursement.

(c) The applicability of this section does not depend upon whether the victim reports
the offense to law enforcement or the existence or status of any investigation or prosecution.

new text begin (d) A county's obligation to pay the costs incurred for an examination is in no way
altered by chapter 62W.
new text end

Sec. 11.

Minnesota Statutes 2014, section 629.341, subdivision 3, is amended to read:

Subd. 3.

Notice of rights.

The peace officer shall tell the victim whether a shelter or
other services are available in the community and give the victim immediate notice of
the legal rights and remedies available. The notice must include furnishing the victim a
copy of the following statement:

"IF YOU ARE THE VICTIM OF DOMESTIC VIOLENCE, you can ask the city or
county attorney to file a criminal complaint. You also have the right to go to court and
file a petition requesting an order for protection from domestic abuse. The order could
include the following:

(1) an order restraining the abuser from further acts of abuse;

(2) an order directing the abuser to leave your household;

(3) an order preventing the abuser from entering your residence, school, business,
or place of employment;

(4) an order awarding you or the other parent custody of or parenting time with
your minor child or children; or

(5) an order directing the abuser to pay support to you and the minor children if
the abuser has a legal obligation to do so."

The notice must include the resource listing, including telephone number, for the area
battered women's shelter, to be designated by the Department of Corrections. new text begin The notice
must also include the victim's right to seek medical treatment for injuries, both physical
and mental, as a result of the assault, at no cost to the victim, as provided in chapter 62W.
new text end

Sec. 12. new text begin APPROPRIATION; STATE-SPONSORED HEALTH CARE
PROGRAMS.
new text end

new text begin $3,915,000 is appropriated in fiscal years 2016 and 2017 to the commissioner of
human services for the payment of the per-enrollee fee under the Healthcare Access
for Recovery and Treatment of Survivors Act (HARTS Act) under Minnesota Statutes,
chapter 62W.
new text end