as introduced - 89th Legislature (2015 - 2016) Posted on 03/10/2016 03:17pm
A bill for an act
relating to health care cost containment; modifying coverage and billing
requirements; proposing coding for new law in Minnesota Statutes, chapter 62Q;
repealing Minnesota Statutes 2014, section 62K.11.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
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(a) Except as provided in
paragraph (c), unauthorized provider services occur when an enrollee receives services:
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(1) from a nonparticipating provider at a participating hospital or ambulatory
surgical center, when the services are rendered:
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(i) due to the unavailability of a participating provider;
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(ii) by a nonparticipating provider without the enrollee's knowledge; or
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(iii) due to the need for unforeseen services arising at the time the services are
being rendered;
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(2) from a nonparticipating provider in a participating provider's practice setting
under circumstances not described in clause (1);
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(3) from a participating provider, but the services are not covered by the health plan;
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(4) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or
other medical testing facility; or
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(5) not described in clause (3) or (4) that are performed by a nonparticipating
provider, if a referral for the services is required by the health plan.
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(b) Unauthorized provider services do not include emergency services as defined
in section 62Q.55, subdivision 3.
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(c) The services described in paragraph (a), clauses (2) to (5), are not unauthorized
provider services if the enrollee gives advance written consent to the provider
acknowledging that the use of a provider, or the services to be rendered, may result in
costs not covered by the health plan.
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A health plan company shall not impose coverage restrictions
or limitations on unauthorized provider services that are more restrictive than those that
apply to services received by the enrollee from a participating provider. All cost-sharing
requirements for unauthorized provider services, including co-payments, deductibles, or
coinsurance, must be the same as the cost-sharing requirements applicable to services
received by the enrollee from a participating provider.
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This section is effective January 1, 2017, and applies to health
plans offered, issued, or renewed to a Minnesota resident on or after that date.
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A participating provider is prohibited from billing an enrollee for any amount in
excess of the allowable amount the health plan company has contracted for with the
provider as total payment for the health care services. A participating provider is permitted
to bill an enrollee the approved co-payment, deductible, or coinsurance.
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This section is effective January 1, 2017, and applies to health
plans offered, issued, or renewed to a Minnesota resident on or after that date.
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Minnesota Statutes 2014, section 62K.11,
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is repealed effective January 1, 2017.
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