SF 2610

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 09:25am

A bill for an act
relating to commerce; prohibiting noncovered discounts for vision care provided
by health and vision plans; adding optometrists to a definition of health care
provider; amending Minnesota Statutes 2012, section 62Q.74, subdivision 1;
proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

Minnesota Statutes 2012, section 62Q.74, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) For purposes of this section, "category of coverage"
means one of the following types of health-related coverage:

(1) health;

(2) no-fault automobile medical benefits; or

(3) workers' compensation medical benefits.

(b) "Health care provider" or "provider" means a physician, chiropractor,
new text begin optometrist, ophthalmologist, new text end dentist, podiatrist, hospital, ambulatory surgical center,
freestanding emergency room, or other provider, as defined in section 62J.03.

Sec. 2.

new text begin [62Q.741] PROHIBITION OF NONCOVERED DISCOUNTS; VISION
CARE PROVIDED BY HEALTH AND VISION PLANS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin For purposes of this section:
new text end

new text begin (a) "Contractual discount" means a percentage reduction from a provider's usual
and customary rate for covered services and materials required under a participating
provider agreement.
new text end

new text begin (b) "Covered services" means services and materials for which reimbursement
from the vision plan is provided for by an enrollee's plan or contract, or for which a
reimbursement would be available but for the application of the enrollee's contractual
limitations of deductibles, co-payments, and coinsurance.
new text end

new text begin (c) "Health care provider" or "provider" has the meaning given in section 62Q.74,
subdivision 1, paragraph (b).
new text end

new text begin (d) "Materials" includes but is not limited to lenses, devices containing lenses,
prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and
prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human
eye or its adnexa.
new text end

new text begin Subd. 2. new text end

new text begin Noncovered vision care under health or vision plans prohibited.
new text end

new text begin No contract or other agreement between an insurer or another entity that writes vision
insurance and an optometrist or ophthalmologist, for the provision of vision services on a
preferred or in-network basis to plan members or insurance subscribers in connection with
coverage under a stand-alone vision plan, a medical plan, or a health insurance policy,
may require that an optometrist or ophthalmologist provide services or materials at a fee
limited or set by the plan or insurer unless the services or materials are reimbursed as
covered services under the contract or other agreement.
new text end

new text begin Subd. 3. new text end

new text begin Provider charges, contractual discounts, and nominal reimbursements.
new text end

new text begin (a) A provider shall not charge more for services and materials that are noncovered
services and materials under a vision plan than the provider's usual and customary rate
for those services and materials.
new text end

new text begin (b) The amount of a contractual discount shall not result in a fee less than the health
or vision plan would pay for covered services and materials, but for the application of an
enrollee's contractual limitations of deductibles, co-payments, and coinsurance.
new text end

new text begin (c) Reimbursement paid by the vision plan for covered services and materials shall
be reasonable and shall not provide nominal or de minimis reimbursement in order to
claim that services and materials are covered services.
new text end

Sec. 3. new text begin EFFECTIVE DATE.
new text end

new text begin Sections 1 and 2 are effective August 1, 2014, and apply to health or vision plans
offered, sold, issued, or renewed on or after that date.
new text end