SF 3389

as introduced - 89th Legislature (2015 - 2016) Posted on 04/01/2016 09:23am

A bill for an act
relating to health insurance; clarifying that a health maintenance contract may
not impose an out-of-pocket maximum greater than is permitted under the
Affordable Care Act; requiring health plan companies to offer a provider contract
to any provider that meets certain criteria; amending Minnesota Statutes 2014,
section 62D.095, subdivision 4; 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 2014, section 62D.095, subdivision 4, is amended to read:

Subd. 4.

Annual out-of-pocket maximums.

A health maintenance contract may
impose an annual out-of-pocket maximum consistent with the provisions of the Affordable
Care Act as defined under section 62A.011, subdivision 1a. new text begin No health maintenance
contract may impose a greater out-of-pocket maximum than is permitted under the
Affordable Care Act.
new text end

Sec. 2.

new text begin [62Q.195] ANY WILLING PROVIDER.
new text end

new text begin (a) No health plan company shall deny a health care provider the right to participate
in any of its provider network contracts in this state if:
new text end

new text begin (1) the provider's scope of practice is covered under the health plan;
new text end

new text begin (2) the provider is located within the area served by the health plan company;
new text end

new text begin (3) the provider meets the health plan company's credentialing standards; and
new text end

new text begin (4) the provider agrees to meet all data requirements, utilization review, and quality
assurance requirements that may be imposed by the health plan company.
new text end

new text begin (b) No health plan company shall impose a co-payment, fee, or other cost-sharing
requirement for selecting a particular health care provider of the enrollee's choosing or
impose other conditions that limit or restrict an enrollee's ability to utilize a specific health
care provider of the enrollee's choosing, unless the health plan company imposes the same
cost-sharing requirements, fees, or conditions on an enrollee's selection of any of the
health care providers within the health plan company's provider network in this state.
new text end

new text begin (c) For purposes of this section, health care provider has the meaning defined in
section 62Q.733, subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2017.
new text end