SF 2285

as introduced - 93rd Legislature (2023 - 2024) Posted on 03/02/2023 09:01am

A bill for an act
relating to health care; permitting health care providers to establish and make
available to the public retail prices for bundles of elective medical services; making
a provider's itemized price for an individual binding on the provider in certain
circumstances; prohibiting certain provider contracts; prohibiting certain retaliation
against providers; 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.825] HEALTH CARE PROVIDERS; DISCLOSURE OF RETAIL
PRICES AND ITEMIZED PRICES FOR BUNDLES OF ELECTIVE MEDICAL
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section
and section 62J.826.
new text end

new text begin (b) "Bundle of elective medical services" means a set of health care services specified
by a health care provider, according to accepted and prevailing standards of practice, to
treat a specific medical condition, illness, or injury of a patient on an elective basis and
within a period of time specified by the health care provider.
new text end

new text begin (c) "Facility fee" has the meaning given in section 62J.824.
new text end

new text begin (d) "Health care provider" or "provider" means:
new text end

new text begin (1) a physician, physician assistant, advanced practice registered nurse, dentist, or
pharmacist licensed in this state; or
new text end

new text begin (2) a hospital licensed under sections 144.50 to 144.58.
new text end

new text begin (e) "Health plan" has the meaning given in section 62Q.01, subdivision 3.
new text end

new text begin (f) "Itemized price" means a price that is established by a health care provider for a
bundle of elective medical services for an individual patient and that meets the requirements
in subdivision 5.
new text end

new text begin (g) "Retail price" means the cash amount a health care provider commonly charges,
determined on a pretreatment basis, for a bundle of elective medical services.
new text end

new text begin Subd. 2. new text end

new text begin Retail prices for bundles of elective medical services. new text end

new text begin (a) A health care
provider that furnishes 25 or more bundles of elective medical services to patients, alone
or under contracts with one or more other health care providers or allied health professionals,
may make available to the public the retail prices for at least 25 bundles of elective medical
services identified by the provider. A health care provider that furnishes fewer than 25
bundles of elective medical services to patients may make available to the public the retail
prices for the bundles of elective medical services furnished by the provider. The bundles
for which retail prices are made available may include bundles of elective medical services,
if any, that the provider commonly furnishes to patients on an outpatient basis in an
emergency department.
new text end

new text begin (b) A health care provider that chooses to make retail prices available under this
subdivision must make available at least the following information:
new text end

new text begin (1) the list of bundles of elective medical services and corresponding retail prices;
new text end

new text begin (2) the amount of the facility fee, if any, included in each retail price; and
new text end

new text begin (3) a notice that the health care provider may adjust a retail price for a bundle of elective
medical services for an individual patient, based on the patient's health status and the
complexity of the patient's medical condition, illness, or injury.
new text end

new text begin (c) The information specified in paragraph (b) must be posted on the provider's website,
made available from the provider's business office, and made available in the provider's
reception area or waiting room.
new text end

new text begin (d) If a health care provider that chooses to make retail prices available under this
subdivision is affiliated with a health care facility, medical clinic, or health system, the
health care provider may opt to have the health care facility, medical clinic, or health system
make available the information specified in paragraph (b) on the website of the facility,
clinic, or system; from the business office of the facility, clinic, or system; and in the
reception area or waiting room of the facility or clinic. Notwithstanding paragraph (c), a
health care provider that opts to have the facility, clinic, or system make available the
information specified in paragraph (b) may but is not required to also make the information
available on the provider's website, from the provider's business office, and in the provider's
reception area or waiting room.
new text end

new text begin Subd. 3. new text end

new text begin Updating list and prices. new text end

new text begin A health care provider shall periodically update the
information made available to the public under subdivision 2 upon a change in retail price,
facility fee, or bundle of elective medical services.
new text end

new text begin Subd. 4. new text end

new text begin Health care provider not required to enter into arrangement. new text end

new text begin A health care
provider is not required to enter into an arrangement with a specific patient to provide a
bundle of elective medical services to that patient.
new text end

new text begin Subd. 5. new text end

new text begin Itemized price for individual patient. new text end

new text begin At the request of a patient and at no
cost to the patient, a health care provider may provide the patient with an itemized price for
a bundle of elective medical services listed by the provider under subdivision 2. If the health
care provider chooses to provide an itemized price to a patient, the itemized price:
new text end

new text begin (1) must be based on the retail price made available to the public under subdivision 2
for that bundle of elective medical services;
new text end

new text begin (2) may be modified by the provider based on the patient's health status and the
complexity of the patient's medical condition, illness, or injury;
new text end

new text begin (3) must include an itemized list of the health care services in the bundle and an itemized
list of the health care services or types of health care services excluded from the bundle;
and
new text end

new text begin (4) must not include charges for health care services or types of health care services the
provider excludes from the bundle or charges for unexpected but necessary medical care,
but for which the patient is obligated to pay.
new text end

new text begin Subd. 6. new text end

new text begin Patient acceptance of itemized price; effect. new text end

new text begin (a) If a patient acknowledges
the health care services included in and excluded from a bundle of elective medical services,
accepts the health care provider's itemized price for the bundle, and pays the provider that
amount or enters into an agreement to pay the provider that amount before being provided
with the bundle of elective medical services, the itemized price is binding on the provider
for that bundle provided to that patient.
new text end

new text begin (b) If a patient accepts the health care provider's itemized price and is covered by a health
plan and if the patient's health plan company agrees to pay the itemized price for the bundle
of elective medical services, the health plan company shall:
new text end

new text begin (1) pay the provider the itemized price for that bundle, before the patient is provided
with that bundle, as payment in full for that bundle provided to that patient; or
new text end

new text begin (2) reimburse the patient for the amount of the itemized price, if the patient has already
paid the provider that amount, as payment in full for that bundle provided to that patient.
new text end

new text begin Subd. 7. new text end

new text begin Antitrust. new text end

new text begin The provision of retail prices according to this section shall not
constitute a violation of state or federal antitrust laws.
new text end

Sec. 2.

new text begin [62J.826] PROHIBITED PROVIDER CONTRACTS; RETALIATION
PROHIBITED.
new text end

new text begin Subdivision 1. new text end

new text begin Prohibited provider contracts. new text end

new text begin No contract between a health care
provider and a health plan company, health care facility, medical clinic, or health system
shall prohibit, restrict, or penalize a health care provider from disclosing to the public and
patients a list of bundles of elective medical services, itemized lists of health care services
included in and excluded from the provider's listed bundles of elective medical services,
retail prices, facility fees, and itemized prices as permitted under section 62J.825, provided
the information disclosed is accurate.
new text end

new text begin Subd. 2. new text end

new text begin Retaliation prohibited. new text end

new text begin No health plan company, health care facility, medical
clinic, or health system shall retaliate against a health care provider solely on the ground
that the provider disclosed to the public and patients a list of bundles of elective medical
services, itemized lists of health care services included in and excluded from the provider's
listed bundles of elective medical services, retail prices, facility fees, or itemized prices as
permitted under section 62J.825, provided the information disclosed is accurate.
new text end