HF 4547

as introduced - 91st Legislature (2019 - 2020) Posted on 04/14/2020 11:19am

A bill for an act
relating to health; modifying requirements for information on patient medical bills;
establishing health care price transparency requirements; amending Minnesota Statutes 2018, sections 62J.701; 62J.72, subdivision 3; proposing coding for new law in Minnesota Statutes, chapter 62J.

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

Section 1.

Minnesota Statutes 2018, section 62J.701, is amended to read:

62J.701 GOVERNMENTAL PROGRAMS.

deleted text begin (a) Beginning January 1, 1999, the provisions in paragraphs (b) to (e) apply.
deleted text end

deleted text begin (b) deleted text end new text begin (a) new text end For purposes of sections 62J.695 to 62J.80, the requirements and other provisions
that apply to health plan companies also apply to governmental programs.

deleted text begin (c) deleted text end new text begin (b) new text end For purposes of this section, "governmental programs" means the medical
assistance program, the MinnesotaCare program, the state employee group insurance
program, the public employees insurance program under section 43A.316, and coverage
provided by political subdivisions under section 471.617.

deleted text begin (d) deleted text end new text begin (c) new text end Notwithstanding paragraph deleted text begin (b) deleted text end new text begin (a) new text end , section 62J.72 deleted text begin does deleted text end new text begin , subdivisions 1, 2, and 3,
paragraph (a), do new text end not apply to the fee-for-service programs under medical assistance and
MinnesotaCare new text begin , and section 62J.72, subdivision 3, paragraph (b), does not apply to enrollees
covered by medical assistance, MinnesotaCare, or Medicare new text end .

deleted text begin (e) deleted text end new text begin (d) new text end If a state commissioner or local unit of government contracts with a health plan
company or a third-party administrator, the contract may assign any obligations under
paragraph deleted text begin (b) deleted text end new text begin (a) new text end to the health plan company or third-party administrator. Nothing in this
paragraph shall be construed to remove or diminish any enforcement responsibilities of the
commissioners of health or commerce provided in sections 62J.695 to 62J.80.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62J.72, subdivision 3, is amended to read:

Subd. 3.

Information on patients' medical bills.

new text begin (a) new text end A health plan company and health
care provider shall provide patients and enrollees with a copy of an explicit and intelligible
bill deleted text begin whenever the patient or enrollee is sent a bill and is responsible for paying any portion
of that bill deleted text end . The deleted text begin bills deleted text end new text begin bill new text end must contain descriptive language sufficient to be understood by
the average patient or enrollee. new text begin A patient or enrollee may request in writing from a provider
or health plan company an itemized bill that includes all charges for which the provider
bills the patient for services provided. new text end This subdivision does not apply to a flat co-pay paid
by the patient or enrollee at the time the service is required.

new text begin (b) In addition to the requirements in paragraph (a), when a health care provider transmits
a bill to a patient, the bill must specify the following for the health care services provided:
new text end

new text begin (1) the dollar amount the provider is willing to accept as payment in full;
new text end

new text begin (2) the Medicare-allowable fee-for-service payment rate; and
new text end

new text begin (3) the provider's Medicare percent, as defined in section 62J.84, subdivision 1.
new text end

new text begin For patients covered by a health plan, a provider must also include a copy of the Medicare
percent disclosure form signed by the patient or the patient's representative, as required
under section 62J.84, subdivision 4.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end

Sec. 3.

new text begin [62J.84] HEALTH CARE PRICE TRANSPARENCY; NOTICE AND
DISCLOSURE OF MEDICARE PERCENT.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the terms in this subdivision
have the meanings given.
new text end

new text begin (b) "Health plan" has the meaning given in section 62A.011, subdivision 3, and does
not include coverage provided under medical assistance, MinnesotaCare, or Medicare Part
A, Part B, or Part C.
new text end

new text begin (c) "Medicare percent" means the percentage of the Medicare allowable payment rate
that a health care provider is willing to accept as payment in full for health care services
provided by that provider.
new text end

new text begin Subd. 2. new text end

new text begin Required notice. new text end

new text begin (a) A health care provider must establish a Medicare percent
that the provider is willing to accept as payment in full for health care services provided by
that provider. A provider must provide notice to patients and the public of the provider's
Medicare percent by:
new text end

new text begin (1) posting information describing the Medicare percent and specifying the provider's
Medicare percent in a prominent, clearly visible location at or near the provider's reception
desk, registration desk, or patient check-in area;
new text end

new text begin (2) posting information describing the Medicare percent and specifying the provider's
Medicare percent on the provider's public website; and
new text end

new text begin (3) including information describing the Medicare percent and specifying the provider's
Medicare percent on any document related to provider payments that the provider requires
a patient or patient's representative to sign.
new text end

new text begin (b) The notices required in paragraph (a) must include the following statement: "The
Medicare percent means the percentage of Medicare reimbursement that this provider will
accept as payment in full for services provided to patients. The Medicare percent can be
used by a patient to compare the cost of care between providers."
new text end

new text begin Subd. 3. new text end

new text begin Application of hospital's, health care facility's, or clinic's Medicare percent
to employed, affiliated, or contracted providers. new text end

new text begin An individual health care provider
employed by, affiliated with, or under contract with a hospital, health care facility, or medical
clinic shall not be reimbursed at an amount greater than the amount of the hospital's or
clinic's Medicare percent established under subdivision 1.
new text end

new text begin Subd. 4. new text end

new text begin Medicare percent disclosure form. new text end

new text begin (a) Before providing health care services
to a patient, a health care provider must: (1) provide the patient or patient's representative
with a Medicare percent disclosure form describing the Medicare percent; and (2) obtain
the signature of the patient or patient's representative on a copy of the form retained by the
provider. The Medicare percent disclosure form of a hospital, health care facility, or medical
clinic must also include the following statement in 12-point, bold type: "ALL PROVIDERS
OF HEALTH CARE SUPPORT SERVICES, INCLUDING SERVICES PROVIDED BY
HEALTH PROFESSIONALS, THAT FORM A PART OF THE HEALTH CARE FOR
PATIENTS AT THIS FACILITY OR CLINIC HAVE AGREED TO ACCEPT THE
FACILITY'S OR CLINIC'S MEDICARE PERCENT AS PAYMENT IN FULL FOR THEIR
SERVICES." Except as provided in paragraph (c), if a provider fails to provide a patient or
patient's representative with the disclosure form required by this paragraph, the provider is
subject to a $1,000 fine to be paid to the patient or credited to the patient's account with the
provider.
new text end

new text begin (b) For patients covered by a health plan, a provider must include a copy of the disclosure
form signed by the patient or patient's representative with all bills submitted to a health plan
company. If a provider fails to include a copy of the signed disclosure form in a bill submitted
to a health plan company, the provider shall not be reimbursed at an amount greater than
the Medicare-allowable payment rate for the services listed on the provider's bill as payment
in full for those services.
new text end

new text begin (c) A provider shall be reimbursed at 200 percent of the Medicare-allowable payment
rate for a specific health care service or at the provider's disclosed Medicare percent,
whichever is less, if a provider fails to provide a patient or patient's representative with the
disclosure form required in paragraph (a) because:
new text end

new text begin (1) the patient is unconscious or incapacitated and unable to sign the disclosure form;
and
new text end

new text begin (2) no representative for the patient is present at the time health care services are provided
to the patient.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021.
new text end