SF 2745

as introduced - 90th Legislature (2017 - 2018) Posted on 02/27/2018 09:30am

A bill for an act
relating to health care; adding enforcement authority to the price disclosure
requirements for providers and health plan companies; amending Minnesota Statutes
2016, section 62J.81.

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

Section 1.

Minnesota Statutes 2016, section 62J.81, is amended to read:

62J.81 DISCLOSURE OF PAYMENTS FOR HEALTH CARE SERVICES.

Subdivision 1.

Required disclosure deleted text begin of estimated payment deleted text end new text begin by provider new text end .

(a) A health
care provider, as defined in section 62J.03, subdivision 8, or the provider's designee as
agreed to by that designee, shall, at the request of a consumer, and at no cost to the consumer
or the consumer's employer, provide that consumer with a good faith estimate of the allowable
payment the provider has agreed to accept from the consumer's health plan company for
the services specified by the consumer, specifying the amount of the allowable payment
due from the health plan company. deleted text begin Health plan companies must allow contracted providers,
or their designee, to release this information. deleted text end If a consumer has no applicable public or
private coverage, the health care provider must give the consumer, and at no cost to the
consumer, a good faith estimate of the average allowable reimbursement the provider accepts
as payment from private third-party payers for the services specified by the consumer and
the estimated amount the noncovered consumer will be required to pay.

new text begin (b) In addition to the information required to be disclosed under paragraph (a), a provider
must also provide the consumer with information regarding other types of fees or charges
that the consumer may be required to pay in conjunction with a visit to the provider, including
but not limited to any applicable facility fees.
new text end

new text begin (c) The information required under this subdivision must be provided to a consumer
within two business days from the day the request was received.
new text end

new text begin (d) new text end Payment information provided by a provider, or by the provider's designee as agreed
to by that designee, to a patient pursuant to this subdivision does not constitute a legally
binding estimate of the allowable charge for or cost to the consumer of services.

new text begin (e) No contract between a health plan company and a provider shall prohibit a provider
from disclosing the pricing information required under this subdivision.
new text end

new text begin Subd. 1a. new text end

new text begin Required disclosure by health plan company. new text end

deleted text begin (b) deleted text end new text begin (a) new text end A health plan company,
as defined in section 62J.03, subdivision 10, shall, at the request of an enrollee intending
to receive specific health care services or the enrollee's designee, provide that enrollee with
a good faith estimate of the allowable amount the health plan company has contracted for
with a specified provider within the network as total payment for a health care service
specified by the enrollee and the portion of the allowable amount due from the enrollee and
the enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph
is not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.

new text begin (b) The information required under this subdivision must be provided by the health plan
company to an enrollee within two business days from the day the request was received.
new text end

deleted text begin Subd. 2. deleted text end

deleted text begin Applicability. deleted text end

deleted text begin For purposes of this section, "consumer" does not include a
medical assistance or MinnesotaCare enrollee, for services covered under those programs.
deleted text end

new text begin Subd. 3. new text end

new text begin Enforcement. new text end

new text begin (a) The commissioner of health shall enforce this section. Any
provider or health plan company found in violation of this section may be subject to a fine
of up to $1,000 a day, not to exceed $10,000 per violation. Any fine levied under this
subdivision is subject to the contested case hearing and judicial review process of chapter
14.
new text end

new text begin (b) Nothing in paragraph (a) precludes a provider from disciplinary action by a
health-related licensing board; or a health plan company from being subject to section 45.027
or chapters 62D or 72A.
new text end

new text begin Subd. 4. new text end

new text begin Applicability. new text end

new text begin For purposes of this section, "consumer" does not include a
medical assistance or MinnesotaCare enrollee, for services covered under those programs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective July 1, 2019.
new text end