SF 696

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 02:15am

A bill for an act
relating to human services; requiring patient-centered decision-making process
before certain procedures are reimbursed under state employee health insurance
program and medical assistance; amending Minnesota Statutes 2008, sections
43A.23, subdivision 1; 256B.76, by adding a subdivision; proposing coding for
new law in Minnesota Statutes, chapter 62U.

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

Section 1.

Minnesota Statutes 2008, section 43A.23, subdivision 1, is amended to read:

Subdivision 1.

General.

(a) The commissioner is authorized to request proposals
or to negotiate and to enter into contracts with parties which in the judgment of the
commissioner are best qualified to provide service to the benefit plans. Contracts entered
into are not subject to the requirements of sections 16C.16 to 16C.19. The commissioner
may negotiate premium rates and coverage. The commissioner shall consider the cost of
the plans, conversion options relating to the contracts, service capabilities, character,
financial position, and reputation of the carriers, and any other factors which the
commissioner deems appropriate. Each benefit contract must be for a uniform term of at
least one year, but may be made automatically renewable from term to term in the absence
of notice of termination by either party. A carrier licensed under chapter 62A is exempt
from the taxes imposed by chapter 297I on premiums paid to it by the state.

(b) All self-insured hospital and medical service products must comply with coverage
mandates, data reporting, and consumer protection requirements applicable to the licensed
carrier administering the product, had the product been insured, including chapters 62J,
62M, and 62Q. Any self-insured products that limit coverage to a network of providers
or provide different levels of coverage between network and nonnetwork providers shall
comply with section 62D.123 and geographic access standards for health maintenance
organizations adopted by the commissioner of health in rule under chapter 62D.

(c) Notwithstanding paragraph (b), a self-insured hospital and medical product
offered under sections 43A.22 to 43A.30 is not required to extend dependent coverage to
an eligible employee's unmarried child under the age of 25 to the full extent required under
chapters 62A and 62L. Dependent coverage must, at a minimum, extend to an eligible
employee's unmarried child who is under the age of 19 or an unmarried child under the
age of 25 who is a full-time student. The definition of "full-time student" for purposes
of this paragraph includes any student who by reason of illness, injury, or physical or
mental disability as documented by a physician is unable to carry what the educational
institution considers a full-time course load so long as the student's course load is at least
60 percent of what otherwise is considered by the institution to be a full-time course load.
Any notice regarding termination of coverage due to attainment of the limiting age must
include information about this definition of "full-time student."

(d) Beginning January 1, 2010, the health insurance benefit plans offered in the
commissioner's plan under section 43A.18, subdivision 2, and the managerial plan under
section 43A.18, subdivision 3, must include an option for a health plan that is compatible
with the definition of a high-deductible health plan in section 223 of the United States
Internal Revenue Code.

new text begin (e) Beginning January 1, 2010, the commissioner shall require an eligible employee
to participate in a patient-centered decision-making process before a referral is approved
or reimbursement is paid for a surgical procedure for any of the conditions identified
under section 62U.11. For purposes of this paragraph, "patient-centered decision-making
process" has the meaning given under section 62U.11.
new text end

Sec. 2.

new text begin [62U.11] PATIENT-CENTERED DECISION MAKING.
new text end

new text begin (a) By January 1, 2010, the commissioners of human services and finance shall
require active participation in a patient-centered decision-making process before a referral
is approved or reimbursement is paid, either on a fee-for-service basis or by a health
plan company under contract with the commissioner of human services or finance, for
a surgical procedure for any of the following conditions: abnormal uterine bleeding;
benign prostate enlargement; chronic back pain; early stage of breast and prostate cancers;
gastroesophageal reflux disease; hemorrhoids; spinal stenosis; temporomandibular joint
dysfunction; ulcerative colitis; urinary incontinence; uterine fibroids; or varicose veins.
A list of these conditions shall be published in the State Register by October 1, 2009.
The list shall be biennially reviewed by the commissioners and any additions to the list
shall be published in the State Register.
new text end

new text begin (b) For purposes of this section, "patient-centered decision-making process" means a
process that involves directed interaction with the patient to assist the patient in arriving
at an informed objective health care decision regarding the surgical procedure. The
interaction may be conducted by a health care provider or through the electronic use of
decision aids.
new text end

Sec. 3.

Minnesota Statutes 2008, section 256B.76, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Patient-centered decision making. new text end

new text begin Beginning January 1, 2010, prior
authorization shall not be approved or payment reimbursement provided for a surgical
procedure for any condition identified under section 62U.11, either on a fee-for-service
basis by the commissioner or by a health plan under contract with the commissioner, until
the patient or the patient's parent or legal guardian has participated in a patient-centered
decision-making process. For purposes of this subdivision, a "patient-centered
decision-making process" has the meaning given in section 62U.11.
new text end