SF 1250

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/18/2022 10:08am

A bill for an act
relating to health care; requiring health plan companies to establish an appeal
process for providers to access if the provider's contract is terminated for cause;
prohibiting a health plan company from terminating a provider's contract without
cause; amending Minnesota Statutes 2020, section 62Q.733, subdivision 1;
proposing coding for new law in Minnesota Statutes, chapter 62Q; repealing
Minnesota Statutes 2020, section 62Q.56, subdivision 1a.

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

Section 1.

Minnesota Statutes 2020, section 62Q.733, subdivision 1, is amended to read:

Subdivision 1.

Applicability.

For purposes of sections 62Q.732 to deleted text begin 62Q.739 deleted text end new text begin 62Q.7391 new text end ,
the following definitions apply.

Sec. 2.

new text begin [62Q.7391] HEALTH CARE PROVIDER CONTRACT TERMINATION.
new text end

new text begin Subdivision 1. new text end

new text begin Termination for cause. new text end

new text begin (a) A contract between a health care provider
and a health plan company may be terminated by the health plan company for cause only
if the contract includes an appeal process for the provider to appeal the termination. The
health plan company must provide the provider with written notice of termination that
includes:
new text end

new text begin (1) the reasons for the termination;
new text end

new text begin (2) the date upon which the termination is effective; and
new text end

new text begin (3) a statement that the provider has the right to appeal the termination decision and a
description of the appeal process available to the provider to request an appeal.
new text end

new text begin (b) The process must permit the provider with the opportunity to request an appeal and
present any relevant documents and arguments against termination. The process must also
include an internal and an external review, if the internal review upholds the decision to
terminate. The external review must be conducted by an independent external review entity
agreed to by the provider. The decision of the external review entity is final. If the external
review entity determines that the reason for termination is not supported, then the provider's
contract with the health plan company must be reinstated.
new text end

new text begin (c) Each health plan company must submit for approval the appeal process required
under this subdivision to the commissioner of commerce or health depending on the agency
that regulates the health plan company. If the health plan company fails to submit the process
or the appeal process is not approved, the commissioner may take regulatory action against
the health plan company.
new text end

new text begin Subd. 2. new text end

new text begin Termination not for cause. new text end

new text begin A health plan company is prohibited from
terminating a contract with a health care provider without cause.
new text end

Sec. 3. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2020, section 62Q.56, subdivision 1a, new text end new text begin is repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 21-02296

62Q.56 CONTINUITY OF CARE.

Subd. 1a.

Change in health care provider; termination not for cause.

(a) If the contract termination was not for cause and the contract was terminated by the health plan company, the health plan company must provide the terminated provider and all enrollees being treated by that provider with notification of the enrollees' rights to continuity of care with the terminated provider.

(b) The health plan company must provide, upon request, authorization to receive services that are otherwise covered under the terms of the health plan through the enrollee's current provider:

(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one or more of the following conditions:

(i) an acute condition;

(ii) a life-threatening mental or physical illness;

(iii) pregnancy beyond the first trimester of pregnancy;

(iv) a physical or mental disability defined as an inability to engage in one or more major life activities, provided that the disability has lasted or can be expected to last for at least one year, or can be expected to result in death; or

(v) a disabling or chronic condition that is in an acute phase; or

(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected lifetime of 180 days or less.

For all requests for authorization to receive services under this paragraph, the health plan company must grant the request unless the enrollee does not meet the criteria provided in this paragraph.

(c) The health plan company shall prepare a written plan that provides a process for coverage determinations regarding continuity of care of up to 120 days for enrollees who request continuity of care with their former provider, if the enrollee:

(1) is receiving culturally appropriate services and the health plan company does not have a provider in its preferred provider network with special expertise in the delivery of those culturally appropriate services within the time and distance requirements of section 62D.124, subdivision 1; or

(2) does not speak English and the health plan company does not have a provider in its preferred provider network who can communicate with the enrollee, either directly or through an interpreter, within the time and distance requirements of section 62D.124, subdivision 1.

The written plan must explain the criteria that will be used to determine whether a need for continuity of care exists and how it will be provided.