HF 3013

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring coverage of plasma protein treatments; amending
Minnesota Statutes 2006, section 256B.0625, by adding a subdivision; proposing
coding for new law in Minnesota Statutes, chapter 144A.

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

Section 1.

new text begin [144A.435] PLASMA PROTEIN THERAPIES COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section, the following terms have
the meanings given them.
new text end

new text begin (a) "Plasma protein therapies" includes, but is not limited to, the following: all
plasma derived blood clotting products; recombinant Factor VII, Factor VIII, and
Factor IX products; von Willebrand Factor; bypass products for patients with inhibitors;
recombinant-activated Factor VIIa; activated prothrombin complex concentrates,
intravenous intramuscular or subcutaneous immune globulins, and alpha-1 proteinase
inhibitors.
new text end

new text begin (b) "Ancillary infusion equipment" includes, but is not limited to, syringes, needles,
and sterile gauze.
new text end

new text begin (c) "Home care provider" means an individual, organization, association,
corporation, unit of government, or other entity that is regularly engaged in the
delivery, directly or by contractual arrangement, of home care services for a fee for
management of bleeding disorders, such as hemophilia or von Willebrand's disease,
primary immunodeficiency diseases and other conditions reliant on immune globulin
treatment, and alpha-1 anti-trypsin deficiency. At least one home care service must be
provided directly, although additional home care services may be provided by contractual
arrangements. Home care services must be provided in a patient's home setting as
described in subdivision 2. Every home care provider must comply with the minimum
criteria specified in subdivision 2, paragraph (d).
new text end

new text begin Subd. 2. new text end

new text begin Home treatment; required coverage. new text end

new text begin (a) Health plan companies must
cover health care services for the home treatment of bleeding episodes associated with
chronic bleeding disorders such as hemophilia or von Willebrand's disease, and for
the home treatment of primary immunodeficiency diseases, other conditions reliant on
immune globulin treatment, and alpha-1 anti-trypsin disorder.
new text end

new text begin (b) Health plan companies shall contract with home care providers that provide
treatment services for bleeding disorders that meet the minimum standards set out in
paragraph (d) and offer those services to covered persons.
new text end

new text begin (c) Health plan companies shall accept for payment all claims for plasma protein
therapies, ancillary infusion equipment, and home nursing services submitted by home
care providers for preventive care and treatment of bleeding disorders required under
paragraph (a).
new text end

new text begin (d) At a minimum, home care providers, in connection with care specified in this
section, must do the following:
new text end

new text begin (1) supply products and services under a prescription from the covered person's
treating physician and not make any substitutions of plasma protein therapies without
prior approval of the treating physician;
new text end

new text begin (2) supply all needed drugs and ancillary supplies for the administration of plasma
protein therapies, including, but not limited to, needles, syringes, and cold compression
packs;
new text end

new text begin (3) provide directly, or through a third party agency, supportive home nursing
services to assist in the reconstitution and administration of plasma protein therapies,
when such services are prescribed by the treating physician;
new text end

new text begin (4) provide record keeping and documentation and assist covered persons in
obtaining third party reimbursement;
new text end

new text begin (5) provide expedited notification to patients of plasma protein therapy recalls or
withdrawals;
new text end

new text begin (6) provide for proper removal and disposal of hazardous medical waste in
compliance with applicable state and federal law; and
new text end

new text begin (7) provide covered persons, upon request, information about the expected costs for
medication and services that are not otherwise reimbursed by the covered person's health
plan company.
new text end

new text begin (e) The commissioner of health shall compile a list of home care providers who meet
the minimum standards set out in paragraph (d) and make the list available to health plan
companies and, upon request, to covered persons.
new text end

new text begin Subd. 3. new text end

new text begin Clinical laboratory services; coverage required. new text end

new text begin (a) Health plan
companies shall provide payment for services to a clinical laboratory at a hospital that
has a hemophilia program, regardless of whether that hospital's clinical laboratory is
a participating provider in the health plan company, if the covered person's treating
physician determines that use of the clinical laboratory is necessary for either of the
following reasons:
new text end

new text begin (1) the results of laboratory tests are medically necessary sooner than the normal
return time for results from the health plan company's participating clinical laboratory; or
new text end

new text begin (2) accurate test results must be determined by closely supervised venipuncture
procedures and laboratory techniques in a controlled environment, which cannot be
provided by the health plan company's participating clinical laboratory.
new text end

new text begin (b) Health plan companies shall pay the clinical laboratory for all laboratory services
according to the usual and customary fee schedule for such services, but the hospital may
not be reimbursed at a rate less than that provided by the medical assistance fee schedule.
new text end

new text begin Subd. 4. new text end

new text begin Medical screening for von Willebrand's disease. new text end

new text begin Health plan companies
shall require that, prior to covering a complex uterine surgical procedure for menorrhagia, a
medical screening for von Willebrand's disease and other bleeding disorders be performed.
The health plan company shall provide coverage for such required medical screenings.
new text end

new text begin Subd. 5. new text end

new text begin Application to medical assistance. new text end

new text begin The coverage requirements in this
section apply to medical assistance coverage under the same terms and conditions required
of health plan companies.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 49. new text end

new text begin Plasma protein therapies. new text end

new text begin Medical assistance covers plasma protein
therapies under the same terms and conditions required of health plans under section
144A.435.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective August 1, 2007, and apply to coverage issued or
renewed on or after that date.
new text end