SF 1162

1st Engrossment - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; requiring disclosure of and
limiting certain charges to the uninsured; limiting
provider recourse; providing remedies; requiring
disclosure of certain hospital charges; proposing
coding for new law in Minnesota Statutes, chapter 62J.

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

Section 1.

new text begin [62J.82] CHARGES TO UNINSURED; PROVIDER
RECOURSE.
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 defined in this subdivision have the meanings
given them.
new text end

new text begin (b) "Covered individual" means an individual who has health
plan company or public health care program coverage for health
care services.
new text end

new text begin (c) "CPT code" means a code contained in the most current
edition of the Physician's Current Procedural Terminology (CPT)
manual published by the American Medical Association and
available for purchase through the American Medical Association,
Order Department: OP054193, P.O. Box 10950, Chicago, Illinois
60610.
new text end

new text begin (d) "Dependent" has the meaning given under section 62L.02,
subdivision 11.
new text end

new text begin (e) "Health care service" has the meaning given under
section 62J.17, subdivision 2.
new text end

new text begin (f) "Health plan company" has the meaning given under
section 62Q.01, subdivision 4.
new text end

new text begin (g) "Person" means an individual, corporation, firm,
partnership, incorporated or unincorporated association, or any
other legal or commercial entity.
new text end

new text begin (h) "Provider" has the meaning given under section 144.50,
subdivision 2.
new text end

new text begin (i) "Third-party payer" means a health plan company or a
public health care plan or program.
new text end

new text begin (j) "Uninsured individual" means a person or dependent who
does not have health plan company coverage or who is not
otherwise covered by a third-party payer.
new text end

new text begin Subd. 2. new text end

new text begin Notice to uninsured. new text end

new text begin (a) A provider may attempt
to obtain from a person or the person's representative
information about whether any third-party payer may fully or
partially cover the charges for health care services rendered by
the provider to the person.
new text end

new text begin (b) A provider shall inform each person, both orally and in
writing, immediately upon first meeting with that person, or as
soon as practicable thereafter, that uninsured individuals will
be charged or billed for health care services in amounts that do
not exceed the amounts described in subdivision 3.
new text end

new text begin (c) If, at the time health care services are provided, a
person has not provided proof of coverage by a third-party payer
or a provider otherwise determines that the person is an
uninsured individual, the provider, as part of any billing to
the person, shall provide the person with a clear and
conspicuous notice that includes:
new text end

new text begin (1) a statement of charges for health care services
rendered by the provider; and
new text end

new text begin (2) a statement that uninsured individuals will be charged
or billed for health care services in amounts that do not exceed
the amounts described in subdivision 3.
new text end

new text begin (d) For purposes of the notice required under paragraph
(c), a provider may incorporate the items into the provider's
existing billing statements and is not required to develop a
separate notice. All communications to a person required by
this subdivision must be language appropriate.
new text end

new text begin Subd. 3. new text end

new text begin Provider charges to the uninsured. new text end

new text begin In billing
or charging an uninsured individual or the individual's
representative for medically necessary health care services, a
provider must bill by CPT code, or other billing identifier as
may be routinely used for billing that health care service. A
provider shall not bill or charge an uninsured individual or the
individual's representative more than 120 percent of the amount
the provider is paid for that service by a nongovernmental
third-party payer plus any applicable cost-sharing payments
payable by a patient during the previous calendar year. After a
bill or charge is issued under this subdivision, a provider may
not increase the bill or charge.
new text end

new text begin Subd. 4. new text end

new text begin Limitations. new text end

new text begin Notwithstanding any other
provision of law, the amounts paid by uninsured individuals for
health care services according to subdivision 3 does not
constitute a provider's uniform, published, prevailing, or
customary charges, or its usual fees to the general public, for
purposes of any payment limit under the Medicare or medical
assistance programs or any other federal or state financed
health care program.
new text end

new text begin Subd. 5. new text end

new text begin Recourse limited. new text end

new text begin (a) Providers under agreement
with a health plan company or public health care plan or program
to provide health care services shall not have recourse against
covered individuals, or persons acting on their behalf, for
amounts above those specified in the evidence of coverage or
other plan or program document as co-payments or coinsurance for
health care services. This subdivision applies but is not
limited to the following events:
new text end

new text begin (1) nonpayment by the health plan company;
new text end

new text begin (2) insolvency of the health plan company; and
new text end

new text begin (3) breach of the agreement between the health plan company
and the provider.
new text end

new text begin (b) This subdivision does not limit a provider's ability to
seek payment from any person other than the covered individual,
the covered individual's guardian or conservator, the covered
individual's immediate family members, or the covered
individual's legal representative in the event of nonpayment by
a health plan company.
new text end

new text begin Subd. 6. new text end

new text begin Remedies. new text end

new text begin A person may file an action in
district court seeking injunctive relief and damages for
violations of this section. In any such action, a person may
also recover costs and disbursements and reasonable attorney
fees.
new text end

new text begin Subd. 7. new text end

new text begin Grounds for disciplinary action. new text end

new text begin Violations of
this section may be grounds for disciplinary or regulatory
action against a provider by the appropriate licensing board or
agency.
new text end

new text begin Subd. 8. new text end

new text begin Authority of attorney general. new text end

new text begin The attorney
general may investigate violations of this section under section
8.31. The attorney general may file an action for violations of
this section according to section 8.31 or may pursue other
remedies available to the attorney general.
new text end

new text begin Subd. 9. new text end

new text begin Income and asset limitations. new text end

new text begin The provisions of
this section shall not apply to uninsured individuals with an
annual family income above $125,000.
new text end

Sec. 2.

new text begin [62J.83] HOSPITAL COST DISCLOSURE.
new text end

new text begin Subdivision 1. new text end

new text begin Identification of hospital
procedures. new text end

new text begin Based on state or national data, the commissioner
of health shall select the following:
new text end

new text begin (1) the 25 most frequently performed hospital inpatient
procedures;
new text end

new text begin (2) the 25 most frequently performed hospital outpatient
procedures; and
new text end

new text begin (3) the 50 most frequently administered drugs in a hospital
inpatient setting.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin Not later than 45 days after the end of
each calendar quarter, a hospital shall report to the
commissioner of health the average and the median allowable
charge by the hospital or outpatient surgical center for the
procedures and drugs identified in subdivision 1.
new text end

new text begin Subd. 3. new text end

new text begin Computation. new text end

new text begin For purposes of subdivision 2, the
computation of an average and median price for a procedure or a
drug shall be in accordance with a methodology prescribed by the
commissioner of health.
new text end

new text begin Subd. 4. new text end

new text begin Disclosure. new text end

new text begin This information shall be available
to the public on a comparative basis.
new text end