SF 301

as introduced - 90th Legislature (2017 - 2018) Posted on 01/24/2017 08:34am

A bill for an act
relating to health; establishing a waiver dispute process for waiver requests
requested by health carriers or preferred provider organizations on provider
geographic accessibility requirements; amending Minnesota Statutes 2016, section
62K.10, subdivision 5.

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

Section 1.

Minnesota Statutes 2016, section 62K.10, subdivision 5, is amended to read:

Subd. 5.

Waiver.

new text begin (a) new text end A health carrier or preferred provider organization may apply to
the commissioner of health for a waiver of the requirements in subdivision 2 or 3 if it is
unable to meet the statutory requirements. A waiver application must be submitted on a
form provided by the commissioner new text begin at least 90 days prior to the annual open enrollment
period established for the individual market under section 62K.15 new text end and must:

(1) demonstrate with specific data that the requirement of subdivision 2 or 3 is not
feasible in a particular service area or part of a service area new text begin because:
new text end

new text begin (i) the health carrier or preferred provider organization conducted a good-faith search
for providers and there were no providers physically present in the service area; or
new text end

new text begin (ii) the providers physically present in the service area do not meet the health carrier's
or the preferred provider organization's credentialing requirements new text end ; and

(2) include information as to the steps that were and will be taken to address the network
inadequacy.

new text begin (b) A health carrier or preferred provider organization's contract with an exclusive
provider, such as an accountable care organization or other entity operating a health care
delivery system, is not by itself a basis for a waiver from the requirements of this section.
new text end

new text begin (c) The commissioner shall post each waiver submitted under this section on the
department's Web site upon receipt of the waiver request. Within 30 days of posting, an
affected provider or enrollee may dispute the waiver by filing a form provided by the
commissioner. For purposes of this subdivision, "affected" means an enrollee as defined
under section 62K.03, subdivision 4, who is a resident of the county, or a provider operating
within the county for which a waiver request was submitted. The affected provider or enrollee
shall:
new text end

new text begin (1) provide written documentation that the health carrier or preferred provider
organization that submitted the waiver has failed to take adequate actions to address the
network adequacy requirements of subdivisions 2 to 4; or
new text end

new text begin (2) provide written documentation that the health carrier or preferred provider
organization that submitted the waiver misrepresented the actions taken to address network
adequacy in its waiver application.
new text end

new text begin (d) The commissioner shall render a decision in any waiver submitted within 60 days
of receipt of the waiver request. The commissioner's decision is a final agency action. The
affected enrollee or provider aggrieved by a waiver may appeal the commissioner's decision
to grant the waiver to the district court of their county of residence.
new text end

new text begin (e) new text end The waiver shall automatically expire after four years. If a renewal of the waiver is
sought, the commissioner of health shall take into consideration steps that have been taken
to address network adequacy.

Sec. 2. new text begin EFFECTIVE DATE.
new text end

new text begin Section 1 is effective the day following final enactment and applies to health plans with
an effective date on or after January 1, 2018.
new text end