Minnesota Legislature
HF 2768
as introduced - 89th Legislature (2015 - 2016) Posted on 03/10/2016 03:22pm
Bill Text Versions
| Engrossments | ||
|---|---|---|
| Introduction | Posted on 03/08/2016 |
Current Version - as introduced
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A bill for an act
relating to health care cost containment; modifying disclosure and billing
requirements in certain circumstances; amending Minnesota Statutes 2014,
section 62J.81.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2014, section 62J.81, is amended to read:
62J.81 DISCLOSURE OF deleted text begin PAYMENTSdeleted text end new text begin ESTIMATED BILLING AND
PAYMENT AMOUNTSnew text end FOR HEALTH CARE SERVICESnew text begin ; LIMITATION ON
OUT-OF-POCKET COSTSnew text end .
Subdivision 1.
Required disclosure of estimatednew text begin billing andnew text end paymentnew text begin amountsnew text end .
(a) A health care provider, as defined in section 62J.03, subdivision 8, or the provider's
designee as agreed to by that designee, shall, at the request of a consumer, and at no
cost to the consumer or the consumer's employer, provide that consumer with a good
faith estimate of new text begin the total amount the health care provider expects to bill for the health
care services specified by the consumer; new text end the allowable payment the provider has agreed
to accept from the consumer's health plan company for the services specified by the
consumer, specifying the amount of the allowable payment due from the health plan
companynew text begin ; and the consumer's estimated out-of-pocket costs for the services specified by
the consumernew text end . Health plan companies must allow contracted providers, or their designee,
to release this information. If a consumer has no applicable public or private coverage, the
health care provider must give the consumer, and at no cost to the consumer, a good faith
estimate of the average allowable reimbursement the provider accepts as payment from
private third-party payers for the services specified by the consumer and the estimated
amount the noncovered consumer will be required to pay. Payment information provided
by a provider, or by the provider's designee as agreed to by that designee, to a patient
pursuant to this subdivision deleted text begin does not constitutedeleted text end new text begin constitutesnew text end a legally binding estimate of
the allowable charge for or cost to the consumer of servicesnew text begin for purposes of limiting
consumer out-of-pocket costs under subdivision 3new text end .
(b) A health plan company, as defined in section 62J.03, subdivision 10, shall, at the
request of an enrollee intending to receive specific health care services or the enrollee's
designee, provide that enrollee with a good faith estimate of the allowable amount the
health plan company has contracted for with a specified provider within the network
as total payment for a health care service specified by the enrollee and the portion of
the allowable amount due from the enrollee and the enrollee's out-of-pocket costs. An
estimate provided to an enrollee under this paragraph is not a legally binding estimate of
the allowable amount or enrollee's out-of-pocket cost.
Subd. 2.
Applicability.
For purposes of this section, "consumer" does not include
a medical assistancedeleted text begin ,deleted text end new text begin ornew text end MinnesotaCaredeleted text begin , or general assistance medical caredeleted text end enrollee, for
services covered under those programs.
new text begin Subd. 3. new text end
new text begin Limitation on out-of-pocket costs. new text end
new text begin
A health care provider shall not
charge a consumer more than 110 percent of the consumer's estimated out-of-pocket
costs disclosed by the health care provider according to subdivision 1, paragraph (a).
The limitation in this subdivision does not apply to emergency services or to additional
services provided in a consumer's course of treatment for which disclosure was provided
under subdivision 1, paragraph (a), if the provider reasonably determined in the course of
treatment that additional services were needed to treat the consumer. For purposes of this
subdivision, "emergency services" has the meaning given in section 62Q.55, subdivision 3.
new text end