HF 3262

as introduced - 90th Legislature (2017 - 2018) Posted on 03/26/2018 04:43pm

A bill for an act
relating to health care; clarifying that a direct primary care service arrangement is
not insurance; amending Minnesota Statutes 2016, sections 62A.01, by adding a
subdivision; 62A.011, subdivision 3.

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

Section 1.

Minnesota Statutes 2016, section 62A.01, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Direct primary care service arrangements. new text end

new text begin (a) A direct primary care service
arrangement is not insurance and is not subject to this chapter. Entering into a direct primary
care service arrangement is not the business of insurance and is not subject to this chapter
or chapter 60A.
new text end

new text begin (b) A health care provider or agent of a health care provider is not required to obtain a
certificate of authority or license under this chapter or chapter 60A, 62C, 62D, or 62N to
market, sell, or offer to sell a direct primary care service arrangement that meets the
requirements of this subdivision.
new text end

new text begin (c) To be considered a direct primary care service arrangement for purposes of this
subdivision, the arrangement must:
new text end

new text begin (1) be in writing;
new text end

new text begin (2) be signed by the health care provider or agent of the health care provider and the
patient or the patient's legal representative entering into the arrangement;
new text end

new text begin (3) describe and quantify the specific primary care services that are included in the
arrangement;
new text end

new text begin (4) specify the fee to be paid to the health care provider for the arrangement;
new text end

new text begin (5) specify the period of time covered by the arrangement, including the date the
arrangement becomes effective and the date the arrangement expires;
new text end

new text begin (6) prominently state in writing that the arrangement is not health insurance;
new text end

new text begin (7) prohibit the health care provider and the patient from billing a health carrier or other
third-party payer for any of the services provided to the patient under the arrangement; and
new text end

new text begin (8) prominently state that the patient must pay the provider for all services provided by
the provider that are not covered by the arrangement and not otherwise covered by a health
plan.
new text end

new text begin (d) For purposes of this subdivision, the following terms have the meanings given:
new text end

new text begin (1) "direct primary care service arrangement" means a contract between a health care
provider and a patient or the patient's legal representative in which the health care provider
agrees to provide specified primary care services as needed by the patient for an agreed-upon
fee for a specified period of time stated in the arrangement;
new text end

new text begin (2) "health care provider" means an individual, health care clinic, or other entity that is
licensed, registered, or otherwise authorized to provide primary care services in this state;
and
new text end

new text begin (3) "primary care services" means:
new text end

new text begin (i) screening, assessment, diagnosis, and treatment for the purpose of the promotion of
health or the detection and management of disease or injury;
new text end

new text begin (ii) medical supplies and prescription drugs that are administered or dispensed in the
health care provider's office or clinic; and
new text end

new text begin (iii) laboratory work, including routine blood screening or routine pathology screening
performed by a laboratory that is either associated with the health care provider, or is not
associated with the health care provider, but has entered into a contract with the health care
provider to provide laboratory work without charging a fee to the patient for the laboratory
work.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end

Sec. 2.

Minnesota Statutes 2016, section 62A.011, subdivision 3, is amended to read:

Subd. 3.

Health plan.

"Health plan" means a policy or certificate of accident and sickness
insurance as defined in section 62A.01 offered by an insurance company licensed under
chapter 60A; a subscriber contract or certificate offered by a nonprofit health service plan
corporation operating under chapter 62C; a health maintenance contract or certificate offered
by a health maintenance organization operating under chapter 62D; a health benefit certificate
offered by a fraternal benefit society operating under chapter 64B; or health coverage offered
by a joint self-insurance employee health plan operating under chapter 62H. Health plan
means individual and group coverage, unless otherwise specified. Health plan does not
include coverage that is:

(1) limited to disability or income protection coverage;

(2) automobile medical payment coverage;

(3) liability insurance, including general liability insurance and automobile liability
insurance, or coverage issued as a supplement to liability insurance;

(4) designed solely to provide payments on a per diem, fixed indemnity, or
non-expense-incurred basis, including coverage only for a specified disease or illness or
hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a
separate policy, certificate, or contract for insurance; there is no coordination between the
provision of benefits and any exclusion of benefits under any group health plan maintained
by the same plan sponsor; and the benefits are paid with respect to an event without regard
to whether benefits are provided with respect to such an event under any group health plan
maintained by the same plan sponsor;

(5) credit accident and health insurance as defined in section 62B.02;

(6) designed solely to provide hearing, dental, or vision care;

(7) blanket accident and sickness insurance as defined in section 62A.11;

(8) accident-only coverage;

(9) a long-term care policy as defined in section 62A.46 or 62S.01;

(10) issued as a supplement to Medicare, as defined in sections 62A.3099 to 62A.44, or
policies, contracts, or certificates that supplement Medicare issued by health maintenance
organizations or those policies, contracts, or certificates governed by section 1833 or 1876,
section 1851, et seq.; or section 1860D-1, et seq., of title XVIII of the federal Social Security
Act, et seq., as amended;

(11) workers' compensation insurance;

(12) issued solely as a companion to a health maintenance contract as described in section
62D.12, subdivision 1a, so long as the health maintenance contract meets the definition of
a health plan;

(13) coverage for on-site medical clinics; deleted text begin or
deleted text end

(14) coverage supplemental to the coverage provided under United States Code, title
10, chapter 55, Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS) new text begin ; or
new text end

new text begin (15) coverage provided under a direct primary care service arrangement described under
section 62A.01, subdivision 5 new text end .