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Minnesota Legislature

Office of the Revisor of Statutes

HF 551

2nd Engrossment - 91st Legislature (2019 - 2020) Posted on 03/18/2019 03:47pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to human services; modifying provisions governing network adequacy
and provider network notifications; imposing administrative penalties; establishing
network access standards based on appointment wait times for managed care and
county-based purchasing plans; amending Minnesota Statutes 2018, sections
62D.124, subdivision 3, by adding subdivisions; 62D.17, subdivision 1; 62K.075;
62K.10, subdivision 5; 256B.69, by adding a subdivision; 256L.121, subdivision
3; proposing coding for new law in Minnesota Statutes, chapter 62K.

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

Section 1.

Minnesota Statutes 2018, section 62D.124, subdivision 3, is amended to read:


Subd. 3.

deleted text beginExceptiondeleted text endnew text begin Waivernew text end.

deleted text begin The commissioner shall grant an exception to the
requirements of this section according to Minnesota Rules, part 4685.1010, subpart 4, if the
health maintenance organization can demonstrate with specific data that the requirement
of subdivision 1 or 2 is not feasible in a particular service area or part of a service area.
deleted text end new text begin (a)
A health maintenance organization may apply to the commissioner of health for a waiver
of the requirements in subdivision 1 or 2 if it is unable to meet those requirements. A waiver
application must be submitted on a form provided by the commissioner, must be accompanied
by an application fee of $1,000 per county, for each application to waive the requirements
in subdivision 1 or 2 for one or more provider types in that county, and must:
new text end

new text begin (1) demonstrate with specific data that the requirements of subdivision 1 or 2 are not
feasible in a particular service area or part of a service area; and
new text end

new text begin (2) include specific information as to the steps that were and will be taken to address
network inadequacy, and for steps that will be taken prospectively to address network
inadequacy, the time frame within which those steps will be taken.
new text end

new text begin (b) Using the guidelines and standards established under section 62K.10, subdivision 5,
paragraph (b), the commissioner shall review each waiver request and shall approve a waiver
only if:
new text end

new text begin (1) the standards for approval established by the commissioner are satisfied; and
new text end

new text begin (2) the steps that were and will be taken to address the network inadequacy and the time
frame for implementing these steps satisfy the standards established by the commissioner.
new text end

new text begin (c) If, in its waiver application, a health maintenance organization demonstrates to the
commissioner that there are no providers of a specific type or specialty in a county, the
commissioner may approve a waiver in which the health maintenance organization is allowed
to address network inadequacy in that county by providing for patient access to providers
of that type or specialty via telemedicine, as defined in section 62A.671, subdivision 9.
new text end

new text begin (d) A waiver shall automatically expire after four years and cannot be renewed. Upon
or prior to expiration of a waiver, a health maintenance organization unable to meet the
requirements in subdivision 1 or 2 must submit a new waiver application under paragraph
(a) and must also submit evidence of steps the organization took to address the network
inadequacy. When the commissioner reviews a waiver application for a network adequacy
requirement which has been waived for the organization for the most recent four-year period,
the commissioner shall also examine the steps the organization took during that four-year
period to address network inadequacy, and shall only approve a subsequent waiver application
if it satisfies the requirements in paragraph (b), demonstrates that the organization took the
steps it proposed to address network inadequacy, and explains why the organization continues
to be unable to satisfy the requirements in subdivision 1 or 2.
new text end

new text begin (e) Application fees collected under this subdivision shall be deposited in the state
government special revenue fund in the state treasury.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62D.124, is amended by adding a subdivision to
read:


new text begin Subd. 6. new text end

new text begin Complaints alleging violation of network adequacy requirements;
investigation.
new text end

new text begin Enrollees of a health maintenance organization may file a complaint with
the commissioner that the health maintenance organization is not in compliance with the
requirements of subdivision 1 or 2, using the process established under section 62K.105,
subdivision 1. The commissioner shall investigate all complaints received under this
subdivision and may use the program established under section 62K.105, subdivision 2, to
investigate complaints.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62D.124, is amended by adding a subdivision to
read:


new text begin Subd. 7. new text end

new text begin Provider network notifications. new text end

new text begin A health maintenance organization must
provide on the organization's website the provider network for each product offered by the
organization, and must update the organization's website at least once a month with any
changes to the organization's provider network, including provider changes from in-network
status to out-of-network status. A health maintenance organization must also provide on
the organization's website, for each product offered by the organization, a list of the current
waivers of the requirements in subdivision 1 or 2, in a format that is easily accessed and
searchable by enrollees and prospective enrollees.
new text end

Sec. 4.

Minnesota Statutes 2018, section 62D.17, subdivision 1, is amended to read:


Subdivision 1.

Administrative penalty.

The commissioner of health may, for any
violation of statute or rule applicable to a health maintenance organization, or in lieu of
suspension or revocation of a certificate of authority under section 62D.15, levy an
administrative penalty in an amount up to $25,000 for each violation. In the case of contracts
or agreements made pursuant to section 62D.05, subdivisions 2 to 4, each contract or
agreement entered into or implemented in a manner which violates sections 62D.01 to
62D.30 shall be considered a separate violation. new text beginThe commissioner shall impose an
administrative penalty of at least $....... per day that a provider network in a county violates
section 62D.124, subdivision 1 or 2, and may take other enforcement action authorized in
law but shall not also impose an administrative penalty under section 62K.105, subdivision
3, for a violation.
new text endIn determining the level of an administrative penalty, the commissioner
shall consider the following factors:

(1) the number of enrollees affected by the violation;

(2) the effect of the violation on enrollees' health and access to health services;

(3) if only one enrollee is affected, the effect of the violation on that enrollee's health;

(4) whether the violation is an isolated incident or part of a pattern of violations; and

(5) the economic benefits derived by the health maintenance organization or a
participating provider by virtue of the violation.

Reasonable notice in writing to the health maintenance organization shall be given of
the intent to levy the penalty and the reasons therefor, and the health maintenance
organization may have 15 days within which to file a written request for an administrative
hearing and review of the commissioner of health's determination. Such administrative
hearing shall be subject to judicial review pursuant to chapter 14. If an administrative penalty
is levied, the commissioner must divide 50 percent of the amount among any enrollees
affected by the violation, unless the commissioner certifies in writing that the division and
distribution to enrollees would be too administratively complex or that the number of
enrollees affected by the penalty would result in a distribution of less than $50 per enrollee.

Sec. 5.

Minnesota Statutes 2018, section 62K.075, is amended to read:


62K.075 PROVIDER NETWORK NOTIFICATIONS.

(a) A health carrier must new text begin provide on the carrier's website the provider network for each
product offered by the carrier, and must
new text endupdate the carrier's website at least once a month
with any changes to the carrier's provider network, including provider changes from
in-network status to out-of-network status.new text begin A health carrier must also provide on the carrier's
website, for each product offered by the carrier, a list of the current waivers of the
requirements in section 62K.10, subdivision 2 or 3, in a format that is easily accessed and
searchable by enrollees and prospective enrollees.
new text end

(b) Upon notification from an enrollee, a health carrier must reprocess any claim for
services provided by a provider whose status has changed from in-network to out-of-network
as an in-network claim if the service was provided after the network change went into effect
but before the change was posted as required under paragraph (a) unless the health carrier
notified the enrollee of the network change prior to the service being provided. This paragraph
does not apply if the health carrier is able to verify that the health carrier's website displayed
the correct provider network status on the health carrier's website at the time the service
was provided.

(c) The limitations of section 62Q.56, subdivision 2a, shall apply to payments required
by paragraph (b).

Sec. 6.

Minnesota Statutes 2018, section 62K.10, subdivision 5, is amended to read:


Subd. 5.

Waiver.

new text begin(a) new text endA health carrier or preferred provider organization may apply to
the commissioner of health for a waiver of the requirements in subdivision 2 or 3 if it is
unable to meet the statutory requirements. A waiver application must be submitted on a
form provided by the commissionernew text begin, must be accompanied by an application fee of $1,000
for each application to waive the requirements in subdivision 2 or 3 for one or more provider
types per county,
new text end and must:

(1) demonstrate with specific data that the requirement of subdivision 2 or 3 is not
feasible in a particular service area or part of a service area; and

(2) include new text beginspecific new text endinformation as to the steps that were and will be taken to address
the network inadequacynew text begin, and for steps that will be taken prospectively to address network
inadequacy, the time frame within which those steps will be taken
new text end.

new text begin (b) The commissioner shall establish guidelines for evaluating waiver applications,
standards governing approval or denial of a waiver application, and standards for steps that
health carriers or preferred provider organizations must take to address the network
inadequacy and allow the health carrier or preferred provider organization to meet network
adequacy requirements within a reasonable time period. The commissioner shall review
each waiver application using these guidelines and standards and shall approve a waiver
application only if:
new text end

new text begin (1) the standards for approval established by the commissioner are satisfied; and
new text end

new text begin (2) the steps that were and will be taken to address the network inadequacy and the time
frame for taking these steps satisfy the standards established by the commissioner.
new text end

new text begin (c) If, in its waiver application, a health carrier or preferred provider organization
demonstrates to the commissioner that there are no providers of a specific type or specialty
in a county, the commissioner may approve a waiver in which the health carrier or preferred
provider organization is allowed to address network inadequacy in that county by providing
for patient access to providers of that type or specialty via telemedicine, as defined in section
62A.671, subdivision 9.
new text end

new text begin (d) new text endThe waiver shall automatically expire after four yearsnew text begin and cannot be renewednew text end. deleted text beginIf a
renewal of the waiver is sought, the commissioner of health shall take into consideration
steps that have been taken to address network adequacy.
deleted text endnew text begin Upon or prior to expiration of a
waiver, a health carrier or preferred provider organization unable to meet the requirements
in subdivision 2 or 3 must submit a new waiver application under paragraph (a) and must
also submit evidence of steps the carrier or organization took to address the network
inadequacy. When the commissioner reviews a waiver application for a network adequacy
requirement which has been waived for the carrier or organization for the most recent
four-year period, the commissioner shall also examine the steps the carrier or organization
took during that four-year period to address network inadequacy, and shall only approve a
subsequent waiver application that satisfies the requirements in paragraph (b), demonstrates
that the carrier or organization took the steps it proposed to address network inadequacy,
and explains why the carrier or organization continues to be unable to satisfy the requirements
in subdivision 2 or 3.
new text end

new text begin (e) Application fees collected under this subdivision shall be deposited in the state
government special revenue fund in the state treasury.
new text end

Sec. 7.

new text begin [62K.105] NETWORK ADEQUACY COMPLAINTS AND
INVESTIGATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Complaints. new text end

new text begin The commissioner shall establish a clear, easily accessible
process for accepting complaints from enrollees regarding health carrier or preferred provider
organization compliance with section 62K.10, subdivision 2, 3, or 4. Using this process, an
enrollee may file a complaint with the commissioner that a health carrier or preferred provider
organization is not in compliance with the requirements of section 62K.10, subdivision 2,
3, or 4. The commissioner shall investigate all complaints received under this subdivision.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner investigations of provider networks. new text end

new text begin The commissioner shall
establish a program to examine health carrier and preferred provider organization compliance
with the requirements in section 62K.10, subdivisions 2, 3, and 4. Under this program,
department employees or contractors shall seek to make appointments with a range of
provider types in a carrier's or organization's designated provider network to determine
whether covered services are available to enrollees without unreasonable delay, and shall
examine whether the carrier's or organization's network complies with the maximum distance
or travel time requirements for specific provider types. The commissioner shall develop a
schedule to ensure that all health carriers and preferred provider organizations are periodically
examined under this program, and shall also use this program to investigate enrollee
complaints filed under subdivision 1.
new text end

new text begin Subd. 3. new text end

new text begin Administrative penalties. new text end

new text begin The commissioner shall impose on a health carrier
or preferred provider organization an administrative penalty of at least $....... per day that
a provider network violates section 62K.10, subdivision 2, 3, or 4, in a county. The
commissioner may also take other enforcement actions authorized in law for a violation,
except that if the commissioner imposes an administrative penalty under this subdivision,
the commissioner shall not also impose an administrative penalty under section 62D.17,
subdivision 1. The commissioner shall use the factors in section 62D.17, subdivision 1, to
determine the amount of the administrative penalty, and the procedures in section 62D.17,
subdivision 1, apply to administrative penalties imposed under this subdivision.
new text end

Sec. 8.

Minnesota Statutes 2018, section 256B.69, is amended by adding a subdivision to
read:


new text begin Subd. 6e. new text end

new text begin Access standards; appointment wait times. new text end

new text begin (a) Managed care and
county-based purchasing plans must comply with the access standards for appointment wait
times specified in this subdivision.
new text end

new text begin (b) Appointment wait times for primary care services must not exceed 45 days from the
date of an enrollee's request for routine and preventive care and 24 hours for urgent care.
new text end

new text begin (c) Appointment wait times for specialty care services must be in accordance with the
time frame appropriate for the needs of the enrollee or the generally accepted community
standards.
new text end

new text begin (d) Appointment wait times for dental, optometry, lab, and x-ray services must not
exceed 60 days for regular appointments and 48 hours for urgent care. For purposes of this
paragraph, regular appointments for dental care means preventive care and initial
appointments for restorative visits.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for managed care and county-based
purchasing contracts entered into on or after January 1, 2020.
new text end

Sec. 9.

Minnesota Statutes 2018, section 256L.121, subdivision 3, is amended to read:


Subd. 3.

Coordination with state-administered health programs.

The commissioner
shall coordinate the administration of the MinnesotaCare program with medical assistance
to maximize efficiency and improve the continuity of care. This includes, but is not limited
to:

(1) establishing geographic areas for MinnesotaCare that are consistent with the
geographic areas of the medical assistance program, within which participating entities may
offer health plans;

(2) requiring, as a condition of participation in MinnesotaCare, participating entities to
also participate in the medical assistance program;

(3) complying with sections 256B.69, subdivision 3a; 256B.692, subdivision 1; and
256B.694, when contracting with MinnesotaCare participating entities;

(4) providing MinnesotaCare enrollees, to the extent possible, with the option to remain
in the same health plan and provider network, if they later become eligible for medical
assistance or coverage through MNsure and if, in the case of becoming eligible for medical
assistance, the enrollee's MinnesotaCare health plan is also a medical assistance health plan
in the enrollee's county of residence; deleted text beginand
deleted text end

(5) establishing requirements and criteria for selection that ensure that covered health
care services will be coordinated with local public health services, social services, long-term
care services, mental health services, and other local services affecting enrollees' health,
access, and quality of caredeleted text begin.deleted text endnew text begin; and
new text end

new text begin (6) complying with the appointment wait time standards specified in section 256B.69,
subdivision 6e.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective for managed care, county-based
purchasing, and participating entity contracts entered into on or after January 1, 2020.
new text end