HF 566

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health plans; regulating contract 
  1.3             stacking; providing a remedy; proposing coding for new 
  1.4             law in Minnesota Statutes, chapter 62Q. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  [62Q.68] [PRODUCT OR NETWORK CONTRACT 
  1.7   STACKING.] 
  1.8      Subdivision 1.  [RESTRICTIONS.] A preferred provider 
  1.9   organization, managed care organization, health maintenance 
  1.10  organization, provider service organization, or insurance 
  1.11  company shall not include health care providers who have 
  1.12  existing contractual relationships with them into additional 
  1.13  product contracts or new network contracts without offering the 
  1.14  health care provider the opportunity to opt in or opt out of the 
  1.15  new product contract or new network contract.  The health care 
  1.16  provider shall receive the information in subdivision 2 and 
  1.17  shall agree to accept or to reject the new product or network 
  1.18  contract terms before any of the contract terms are enforced, 
  1.19  including fee reductions or discounts, limits on care, or other 
  1.20  terms. 
  1.21     Subd. 2.  [NOTICE.] The preferred provider organization, 
  1.22  managed care organization, health maintenance organization, 
  1.23  provider service organization, or insurance company shall notify 
  1.24  the health care provider in writing of the new product or 
  1.25  network.  The notice must include at least the following: 
  2.1      (1) the network's name, address, and phone number; 
  2.2      (2) a description of the products and the discount or 
  2.3   reduced fee for each product offered; 
  2.4      (3) the names of all payers who may utilize the contracted 
  2.5   provider network; 
  2.6      (4) the number of current enrollees in the provider's 
  2.7   geographical area; and 
  2.8      (5) a disclosure of all terms of the contract for the 
  2.9   discounted or reduced-fee product, including care guidelines, 
  2.10  utilization review criteria, prior authorization process, and 
  2.11  dispute resolution process. 
  2.12  The health care provider has 30 days from the postmark date on 
  2.13  the written notice to respond. 
  2.14     Subd. 3.  [CONTRACT TERMINATIONS RESTRICTED.] The preferred 
  2.15  provider organization, managed care organization, health 
  2.16  maintenance organization, provider service organization, or 
  2.17  insurance company shall not terminate a health care provider's 
  2.18  existing contract based solely on the provider's decision to opt 
  2.19  out of the new product or network contract.  The most recent 
  2.20  agreed upon contractual obligation, if any, will remain in force 
  2.21  until its renewal or termination date. 
  2.22     Subd. 4.  [REMEDY.] If a preferred provider organization, 
  2.23  managed care organization, health maintenance organization, 
  2.24  provider service organization, or insurance company fails to 
  2.25  comply with this section, the provider may maintain an action to 
  2.26  recover two times the total reasonable charges of claims 
  2.27  affected by the pattern or practice in addition to any other 
  2.28  appropriate costs, court costs, and reasonable attorney's fees.