SF 2632

as introduced - 91st Legislature (2019 - 2020) Posted on 03/21/2019 03:40pm

A bill for an act
relating to health insurance; establishing direct primary care service agreements;
authorizing the sale and purchase of short-term insurance; amending Minnesota
Statutes 2018, sections 62A.01, by adding a subdivision; 62A.011, subdivision 3;
62A.65, by adding a subdivision; 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 2018, section 62A.01, is amended by adding a subdivision
to read:

new text begin Subd. 5. new text end

new text begin Direct primary care service agreements. new text end

new text begin (a) A direct primary care service
agreement under section 62Q.20 is not insurance and is not subject to this chapter. Entering
into a direct primary care service agreement is not the business of insurance and is not
subject to this chapter or chapter 60A.
new text end

new text begin (b) A health care provider or agent of a health care provider is not required to obtain a
certificate of authority or license under this chapter or chapter 60A, 62C, 62D, or 62N, to
market, sell, or offer to sell a direct primary care service agreement that meets the
requirements of section 62Q.20.
new text end

Sec. 2.

Minnesota Statutes 2018, section 62A.011, subdivision 3, is amended to read:

Subd. 3.

Health plan.

"Health plan" means a policy or certificate of accident and sickness
insurance as defined in section 62A.01 offered by an insurance company licensed under
chapter 60A; a subscriber contract or certificate offered by a nonprofit health service plan
corporation operating under chapter 62C; a health maintenance contract or certificate offered
by a health maintenance organization operating under chapter 62D; a health benefit certificate
offered by a fraternal benefit society operating under chapter 64B; or health coverage offered
by a joint self-insurance employee health plan operating under chapter 62H. Health plan
means individual and group coverage, unless otherwise specified. Health plan does not
include coverage that is:

(1) limited to disability or income protection coverage;

(2) automobile medical payment coverage;

(3) liability insurance, including general liability insurance and automobile liability
insurance, or coverage issued as a supplement to liability insurance;

(4) designed solely to provide payments on a per diem, fixed indemnity, or
non-expense-incurred basis, including coverage only for a specified disease or illness or
hospital indemnity or other fixed indemnity insurance, if the benefits are provided under a
separate policy, certificate, or contract for insurance; there is no coordination between the
provision of benefits and any exclusion of benefits under any group health plan maintained
by the same plan sponsor; and the benefits are paid with respect to an event without regard
to whether benefits are provided with respect to such an event under any group health plan
maintained by the same plan sponsor;

(5) credit accident and health insurance as defined in section 62B.02;

(6) designed solely to provide hearing, dental, or vision care;

(7) blanket accident and sickness insurance as defined in section 62A.11;

(8) accident-only coverage;

(9) a long-term care policy as defined in section 62A.46 or 62S.01;

(10) issued as a supplement to Medicare, as defined in sections 62A.3099 to 62A.44, or
policies, contracts, or certificates that supplement Medicare issued by health maintenance
organizations or those policies, contracts, or certificates governed by section 1833 or 1876,
section 1851, et seq.; or section 1860D-1, et seq., of title XVIII of the federal Social Security
Act, et seq., as amended;

(11) workers' compensation insurance;

(12) issued solely as a companion to a health maintenance contract as described in section
62D.12, subdivision 1a, so long as the health maintenance contract meets the definition of
a health plan;

(13) coverage for on-site medical clinics; deleted text begin or
deleted text end

(14) coverage supplemental to the coverage provided under United States Code, title
10, chapter 55, Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS) deleted text begin . deleted text end new text begin ; or
new text end

new text begin (15) coverage provided under a direct primary care service agreement described under
section 62Q.20.
new text end

Sec. 3.

Minnesota Statutes 2018, section 62A.65, is amended by adding a subdivision to
read:

new text begin Subd. 7b. new text end

new text begin Extended short-term coverage. new text end

new text begin (a) Notwithstanding subdivision 7, a health
carrier may offer a short-term coverage health plan that meets, at a minimum, the
requirements of paragraph (b). To be eligible to purchase a health plan described in this
subdivision, an individual must purchase a direct primary care services arrangement under
section 62Q.20. The individual must maintain coverage under the direct primary care service
arrangement for each plan year.
new text end

new text begin (b) For purposes of this subdivision, "short-term coverage" means an individual health
plan that:
new text end

new text begin (1) is issued to provided coverage for 365 days;
new text end

new text begin (2) is renewable for up to three consecutive years if the individual maintains a direct
primary care services arrangement;
new text end

new text begin (3) does not cover any preexisting conditions for the first 12 months of coverage,
including preexisting conditions that originated during a previous identical policy or contract
with the same health carrier where coverage was continuous between the previous and the
current policy or contract;
new text end

new text begin (4) is available with an immediate effective date and without underwriting upon receipt
of a completed application indicating eligibility under the health carrier's eligibility
requirements, provided that coverage including optional benefits may be offered on a basis
that does not meet this requirement;
new text end

new text begin (5) covers maternity care and mental health;
new text end

new text begin (6) is guaranteed renewable if the individual maintains a direct primary care provider
arrangement; and
new text end

new text begin (7) must have a lifetime and annual dollar limit of at least $1,000,000.
new text end

new text begin (c) For purposes of this subdivision, "preexisting condition" means a condition for which
the individual received medical treatment, diagnosis, care, or advice within a 60-month
period immediately preceding the plan's effective date. Preexisting condition includes
conditions that produced any symptoms which would have caused a reasonable person to
seek diagnosis, care, or treatment within the 60-month period.
new text end

new text begin (d) An individual who elects to purchase extended short-term coverage under this
subdivision must sign an acknowledgment that includes the following statement, in 14-point
boldface type: "I was offered the opportunity to purchase a health plan that includes all
federally required and state-required health benefit mandates, and I declined to purchase
this coverage. I understand that by choosing this coverage I may have to pay out-of-pocket
costs for health services that are not covered by this plan. Individuals, families, and
employees are free to choose a health plan that does not include some or all state-required
and federally required health benefit mandates. There are no penalties for choosing a health
plan that does not include some or all state-required and federally required health benefit
mandates."
new text end

Sec. 4.

new text begin [62Q.20] DIRECT PRIMARY CARE SERVICE AGREEMENT.
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 following terms have
the meanings given.
new text end

new text begin (b) "Direct agreement" or "direct primary care service agreement" means a written
agreement entered into between a direct primary care practice and a direct patient, or a direct
primary care practice and the direct patient's legal representative, in which the primary care
direct practice charges a direct fee as consideration for being available to provide and
providing direct primary care services to the direct patient.
new text end

new text begin (c) "Direct fee" means a fee charged by a direct primary care practice as consideration
for being available to provide and providing primary care services to a direct patient as
specified in the direct agreement.
new text end

new text begin (d) "Direct patient" means an individual who is party to a direct agreement and entitled
to receive primary care services under the direct agreement from the direct primary care
practice.
new text end

new text begin (e) "Direct primary care practice" or "direct practice" means a primary care provider
who furnishes primary care services through a direct agreement.
new text end

new text begin (f) "Primary care provider" means a physician licensed under chapter 147 or an advanced
practice registered nurse licensed under sections 148.171 to 148.285, authorized to engage
in independent practice and qualified to provide primary care services. Primary care provider
includes an individual primary care provider or a group of primary care providers.
new text end

new text begin (g) "Primary care services" means:
new text end

new text begin (1) routine health care services, including (i) screening, assessment, diagnosis, and
treatment to promote health, and (ii) the detection and management of disease or injury
within the competency and training of the primary care provider;
new text end

new text begin (2) medical supplies and prescription drugs that are administered or dispensed in the
primary care provider's office or clinic; and
new text end

new text begin (3) laboratory work, including routine blood screening and routine pathology screening,
performed by a laboratory that is either associated with the direct primary care practice or
is not associated with the direct primary care practice but has entered into a contract with
the practice to provide laboratory work without charging a fee to the patient for the laboratory
work.
new text end

new text begin Subd. 2. new text end

new text begin Direct primary care services agreement requirements. new text end

new text begin (a) To be considered
a direct primary care service agreement for purposes of this section, the direct agreement
must:
new text end

new text begin (1) be in writing;
new text end

new text begin (2) be signed by the primary care provider or agent of the primary care practice and the
direct patient or the patient's legal representative;
new text end

new text begin (3) allow either party to terminate the direct agreement upon written notice to the other
party within the time period specified in the direct agreement and consistent with this section;
new text end

new text begin (4) describe the scope of the primary care services covered under the direct agreement;
new text end

new text begin (5) specify the fee to be paid on a monthly basis or as specified in the direct agreement;
and
new text end

new text begin (6) specify the duration of the direct agreement.
new text end

new text begin (b) The direct agreement must clearly state that (1) a direct primary care service agreement
is not considered health insurance, (2) a direct primary care service agreement does not
meet the requirements under federal law mandating individuals to purchase health insurance,
and (3) the fees charged in the direct primary care service agreement may not be reimbursed
or applied toward a deductible under a health plan offered through a health plan company.
new text end

new text begin Subd. 3. new text end

new text begin Acceptance and discontinuance of patients. new text end

new text begin (a) A direct practice is prohibited
from declining to accept a new patient or discontinuing care to an existing patient solely on
the basis of the patient's health status. A direct practice may decline to accept a patient if:
new text end

new text begin (1) the practice has reached its maximum capacity;
new text end

new text begin (2) the patient's medical condition prevents the practice from being able to provide the
appropriate level and type of primary care services the patient requires; or
new text end

new text begin (3) the patient has previously terminated a direct agreement with the direct practice
within the preceding year.
new text end

new text begin (b) A direct patient or the patient's legal representative may terminate a direct agreement
for any reason by providing written notice to the direct practice. Termination of the direct
agreement is effective the first day of the month following the month the termination notice
is provided to the direct practice or as specified in the direct agreement.
new text end

new text begin (c) A direct practice may terminate the direct agreement only if the direct patient:
new text end

new text begin (1) fails to pay the monthly fee;
new text end

new text begin (2) has performed an act of fraud;
new text end

new text begin (3) has repeatedly failed to adhere to the recommended treatment plan; or
new text end

new text begin (4) is abusive and presents an emotional or physical danger to the staff or other patients.
new text end

new text begin The direct practice must promptly provide notice of termination to the direct patient or the
patient's legal representative. The notice of termination must state the reason for the
termination and the effective date of the termination.
new text end

new text begin (d) Notwithstanding paragraph (c), a direct practice may also discontinue care to a direct
patient if the direct practice discontinues operation as a direct primary care practice. Notice
must be provided to the direct patient or the patient's legal representative specifying the
effective date of the termination. Notice must be sufficient to provide the patient with the
opportunity to obtain care from another provider.
new text end

new text begin Subd. 4. new text end

new text begin Direct fees. new text end

new text begin (a) The direct fee charged must represent the total amount due for
all primary care services specified in the direct agreement that were provided to the direct
patient within the specified time period. The direct fee must not vary from patient to patient
based on the patient's health status or sex. The direct fee may be paid by the direct patient,
the patient's legal representative, or on the patient's behalf by a third party. The direct fee
may be billed at the end of each monthly period or may be paid in advance for a period not
to exceed 12 months.
new text end

new text begin (b) If a patient chooses to pay the monthly fee in advance, the funds must be held by the
direct practice in a trust account with the monthly fee paid to the direct practice as earned
at the end of each month.
new text end

new text begin (c) Upon receipt of a written notice of termination of the direct agreement from a direct
patient or the patient's legal representative, the direct practice must promptly refund the
unearned direct fees amount held in trust. If the direct practice discontinues care for any
reason described under subdivision 3, the direct practice must promptly refund to the direct
patient the unearned direct fees amount held in trust and at a prorated amount of the direct
fee earned for the current month, based on the date the notice of termination was sent to the
direct patient or the direct patient's legal representative.
new text end

new text begin (d) A direct practice is prohibited from increasing the monthly fee that has been negotiated
with an existing direct patient more frequently than on an annual basis. A direct practice
must provide advance notice of at least 60 days to existing patients of any change in the
direct fee.
new text end

new text begin Subd. 5. new text end

new text begin Conduct of business. new text end

new text begin (a) A direct practice must maintain appropriate accounts
for payments made and services received by a direct patient. Upon request, a direct practice
must provide any data requested to the direct patient or the patient's legal representative.
new text end

new text begin (b) A direct practice must not submit a payment claim to a health plan company for a
primary care service provided to a direct patient that is covered by a direct agreement.
new text end

new text begin (c) A person is prohibited from making, publishing, or disseminating any false, deceptive,
or misleading representation or advertising related to the direct practice's business.
new text end

new text begin (d) A person is prohibited from making, issuing, or circulating, or causing to be made,
issued, or circulated, a misrepresentation of a direct agreement's terms or the benefits or
advantages promised, or use the name or title of a direct agreement to misrepresent the
nature of a direct agreement.
new text end

new text begin Subd. 6. new text end

new text begin Other care not prohibited. new text end

new text begin A direct primary care practice is not prohibited
from providing services to other patients under a separate contract with a health plan
company.
new text end

new text begin Subd. 7. new text end

new text begin Enforcement. new text end

new text begin A violation of this section constitutes unprofessional conduct
and may be grounds for disciplinary action under chapter 147.
new text end