HF 4311

as introduced - 90th Legislature (2017 - 2018) Posted on 04/12/2018 04:46pm

A bill for an act
relating to health; insurance; prohibiting out-of-network health care providers from
balance billing for emergency services; amending Minnesota Statutes 2016, section
62Q.55, subdivision 5.

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

Section 1.

Minnesota Statutes 2016, section 62Q.55, subdivision 5, is amended to read:

Subd. 5.

Coverage restrictions or limitations.

new text begin (a) new text end If emergency services are provided
by a nonparticipating provider, with or without prior authorization, the health plan company
shall not impose coverage restrictions or limitations that are more restrictive than apply to
emergency services received from a participating provider. Cost-sharing requirements that
apply to emergency services received out-of-network must be the same as the cost-sharing
requirements that apply to services received in-network.

new text begin (b) If emergency services are provided by a nonparticipating provider:
new text end

new text begin (1) the nonparticipating provider shall not request payment from the enrollee in addition
to the applicable cost-sharing requirements authorized under paragraph (a);
new text end

new text begin (2) the enrollee shall be held harmless and not liable for payment to the nonparticipating
provider that are in addition to the applicable cost-sharing requirements under paragraph
(a); and
new text end

new text begin (3) the nonparticipating provider shall accept as payment-in-full from the health plan
company an amount equal to the average paid for the emergency services, as determined
and periodically updated by the commissioner of health, using the most recent data available
under section 62U.04, subdivisions 4 and 5.
new text end