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Minnesota Legislature

Office of the Revisor of Statutes

SF 3033

as introduced - 90th Legislature (2017 - 2018) Posted on 03/09/2018 08:52am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health care; requiring health care providers and health plan companies
to provide price transparency to patients and enrollees; proposing coding for new
law in Minnesota Statutes, chapter 62J; repealing Minnesota Statutes 2016, section
62J.81.

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

Section 1.

new text begin [62J.812] HEALTH CARE PRICE TRANSPARENCY.
new text end

new text begin Subdivision 1. new text end

new text begin Most frequent charges disclosure. new text end

new text begin (a) Each health care provider shall
maintain a list of the services that correspond with the provider's 25 most frequently billed
current procedural terminology (CPT) codes, including the provider's five most commonly
billed evaluation and management codes, that are billed for over $25, and of the ten most
frequently billed CPT codes for preventive services.
new text end

new text begin (b) For each service listed in paragraph (a), the provider shall disclose the provider's
charge, the reimbursement rate received for the service from the provider's highest volume
health plan payer in the commercial insurance market, and, if applicable, the Medicare
allowable payment rate and the medical assistance fee-for-service payment rate. For purposes
of this subdivision, "provider's charge" means the dollar amount the provider charges to a
patient who has received the service and who is not covered by private or public health care
coverage.
new text end

new text begin (c) The list described in this subdivision must be updated annually and must be posted
in the provider's reception area of the clinic or office and made available on the provider's
Web site, if the provider maintains a Web site.
new text end

new text begin (d) For purposes of this subdivision, "health care provider" means a primary care provider
or clinic that specializes in family medicine, general internal medicine, gynecology, or
general pediatrics.
new text end

new text begin Subd. 2. new text end

new text begin Estimated payment disclosure by provider. new text end

new text begin (a) Each provider, upon request
of a patient, shall provide the patient with a good faith estimate of the allowable payment
that the provider has agreed to accept from the patient's health plan company for a specific
procedure or service identified by the patient specifying the amount of the allowable payment
due from the health plan company. If the patient is not covered by private or public health
care coverage, or the provider is out of network, the provider must give the patient a good
faith estimate of the amount the patient would be required to pay for the specified procedure
or service. Payment information provided by a provider to a patient according to this
paragraph does not constitute a legally binding estimate of the allowable charge for or cost
to the patient for a specified procedure or service.
new text end

new text begin (b) In addition to the information required under paragraph (a), a provider must also
provide the patient with information regarding other types of fees or charges a patient may
be required to pay in conjunction with a visit to the provider or facility where the procedure
or service would be performed.
new text end

new text begin (c) No contract between a health plan company and a health care provider shall contain
a provision prohibiting the provider from disclosing negotiated pricing information, including
information on out-of-pocket expenses.
new text end

new text begin (d) For purposes of this subdivision, "provider" has the meaning given in section 62J.03,
subdivision 8. For purposes of this subdivision, "allowable payment" means the maximum
reimbursement dollar amount that a patient's health plan allows for a specific procedure or
service.
new text end

new text begin Subd. 3. new text end

new text begin Estimated payment disclosure by health plan. new text end

new text begin (a) A health plan company
shall develop a Web site and toll-free telephone number that enables an enrollee to request
and obtain a good faith estimate of the total payment amount the health plan company has
negotiated with an in-network provider for a specified procedure or service, including
inpatient admissions for nonemergency care and the portion of the total payment amount
that is the responsibility of the enrollee. An estimate provided to an enrollee under this
paragraph is not a legally binding estimate of the total payment amount or an enrollee's
out-of-pocket cost.
new text end

new text begin (b) Access to the company's Web site and telephone number shall be available to each
enrollee at no extra cost to the enrollee and must permit an enrollee to obtain the information
under this subdivision in a format that allows an enrollee to enter the enrollee's specific
health plan, the hospital or health care clinic or provider, and the procedure or service.
new text end

new text begin (c) For purposes of this subdivision, "total payment amount" means the amount the
provider expects to be paid from the health plan company and the patient for providing a
procedure or service.
new text end

Sec. 2. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2016, section 62J.81, new text end new text begin is repealed.
new text end

APPENDIX

Repealed Minnesota Statutes: 18-6402

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

Subdivision 1.

Required disclosure of estimated payment.

(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. Health plan companies must allow contracted providers, or their designee, to release this information. 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. 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.

(b) 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.

Subd. 2.

Applicability.

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