SF 1611

as introduced - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health plans; regulating certain 
  1.3             provisions in managed care agreements between health 
  1.4             plan companies and providers; proposing coding for new 
  1.5             law in Minnesota Statutes, chapter 62Q. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [62Q.60] [DEFINITIONS.] 
  1.8      Subdivision 1.  [TERMS.] For purposes of this section and 
  1.9   section 62Q.61, the terms in this section have the meanings 
  1.10  given. 
  1.11     Subd. 2.  [INTERMEDIARY.] "Intermediary" means a person 
  1.12  authorized by health care providers to negotiate and execute 
  1.13  provider contracts with health plan companies on behalf of the 
  1.14  providers. 
  1.15     Subd. 3.  [MANAGED CARE PLAN.] "Managed care plan" means a 
  1.16  policy, contract, certificate, or agreement offered by a health 
  1.17  plan company to provide, deliver, arrange for, pay for, or 
  1.18  reimburse any of the costs of health care services through the 
  1.19  enrollee's use of health care providers managed, owned, under 
  1.20  contract with, or employed by the health plan company because 
  1.21  the health plan company either requires the use of or creates 
  1.22  incentives, including financial incentives, for the enrollee's 
  1.23  use of those providers. 
  1.24     Sec. 2.  [62Q.61] [CONTRACT PROVISIONS IN MANAGED CARE 
  1.25  CONTRACTS BETWEEN HEALTH PLAN COMPANIES AND PROVIDERS.] 
  2.1      Subdivision 1.  [REQUIRED PROVISIONS.] A contract between a 
  2.2   health plan company and a provider or its representative 
  2.3   concerning the delivery, provision, payment, or offering of care 
  2.4   or services covered by a managed care plan must include the 
  2.5   following: 
  2.6      (1) a provision stating that neither the provider nor the 
  2.7   health plan company shall be prohibited from protesting or 
  2.8   expressing disagreement with a medical decision, medical policy, 
  2.9   or medical practice of the health plan company or provider; and 
  2.10     (2) a provision stating that the health plan company shall 
  2.11  not terminate the contract with a provider because the provider 
  2.12  expresses disagreement with a health plan company's decision to 
  2.13  deny or limit benefits to an enrollee or because the provider 
  2.14  assists the enrollee to seek reconsideration of the health plan 
  2.15  company's decision; or because a provider discusses with a 
  2.16  current, former or prospective patient any aspect of the 
  2.17  patient's medical condition, any proposed treatments or 
  2.18  treatment alternatives, whether covered by the plan or not, 
  2.19  policy provision of a plan, or a provider's personal 
  2.20  recommendation regarding selection of a health plan based on the 
  2.21  provider's personal knowledge of the health needs of the 
  2.22  patients. 
  2.23     Subd. 2.  [ACTION NOT PROHIBITED.] Nothing in subdivision 1 
  2.24  prohibits a health plan company from: 
  2.25     (1) including in its provider contracts a provision that 
  2.26  precludes a provider from making, publishing, disseminating, or 
  2.27  circulating directly or indirectly or aiding, abetting, or 
  2.28  encouraging the making, publishing, disseminating, or 
  2.29  circulating of an oral or written statement or a pamphlet, 
  2.30  circular, article, or literature that is false or maliciously 
  2.31  critical of the health plan company and calculated to injure the 
  2.32  health plan company; 
  2.33     (2) terminating a contract with a provider because the 
  2.34  provider materially misrepresents the provisions, terms, or 
  2.35  requirements of a health plan company's products; or 
  2.36     (3) terminating a contract with a provider pursuant to a 
  3.1   contract provision that allows either party to the contract to 
  3.2   terminate the contract without cause pursuant to specific notice 
  3.3   requirements that are the same for both parties. 
  3.4      Subd. 3.  [CONTRACTS WITH INTERMEDIARIES.] A contract 
  3.5   between a health plan company and an intermediary must contain a 
  3.6   provision requiring that the underlying contract authorizing the 
  3.7   intermediary to negotiate and execute contracts with health plan 
  3.8   companies, on behalf of the providers, comply with the 
  3.9   requirements of subdivision 1. 
  3.10     Subd. 4.  [RESOLUTION OF DISPUTES.] The commissioner shall 
  3.11  not act to arbitrate, mediate, or settle disputes between a 
  3.12  health plan company, its intermediaries, or a provider network 
  3.13  arising under or by reason of a provider contract or its 
  3.14  termination.  Existing dispute resolution mechanisms available 
  3.15  in contract law must be used to resolve disputes. 
  3.16     Subd. 5.  [RULEMAKING.] The commissioner may adopt rules to 
  3.17  carry out the requirements of this section. 
  3.18     Sec. 3.  [EFFECTIVE DATE.] 
  3.19     Sections 1 and 2 are effective January 1, 1998, and apply 
  3.20  to a contract between a health plan company and a provider or 
  3.21  its representative or between a health plan company and an 
  3.22  intermediary that concerns the delivery, provision, payment, or 
  3.23  offering of care or services covered by a managed care plan 
  3.24  issued, renewed, amended, or extended to provide coverage to a 
  3.25  Minnesota resident on or after that date.