2nd Unofficial Engrossment - 92nd Legislature (2021 - 2022) Posted on 05/04/2022 09:28pm
A bill for an act
relating to state government; modifying provisions governing the Department of
Health, health care, health-related licensing boards, prescription drugs, health
insurance, community supports, behavioral health, continuing care for older adults,
child and vulnerable adult protection, economic assistance, direct care and
treatment, preventing homelessness, human services licensing and operations,
opioid litigation settlements, and child care assistance; making forecast adjustments;
providing for fees; providing civil penalties; requiring reports; appropriating money;
amending Minnesota Statutes 2020, sections 34A.01, subdivision 4; 62A.02,
subdivision 1; 62A.25, subdivision 2; 62A.28, subdivision 2; 62A.30, by adding
a subdivision; 62J.2930, subdivision 3; 62J.84, as amended; 62N.25, subdivision
5; 62Q.021, by adding a subdivision; 62Q.1055; 62Q.47; 62Q.55, subdivision 5;
62Q.556; 62Q.56, subdivision 2; 62Q.73, subdivision 7; 62U.04, subdivision 11,
by adding a subdivision; 62U.10, subdivision 7; 119B.011, subdivisions 2, 5, 13,
15; 119B.025, subdivision 4; 119B.19, subdivision 7; 137.68; 144.1201,
subdivisions 2, 4; 144.122; 144.1501, subdivisions 4, 5; 144.1503; 144.1505;
144.1911, subdivision 4; 144.292, subdivision 6; 144.383; 144.497; 144.554;
144.565, subdivision 4; 144.586, by adding a subdivision; 144.6502, subdivision
1; 144.651, by adding a subdivision; 144.69; 144.7055; 144.9501, subdivisions 9,
26a, 26b; 144.9505, subdivisions 1, 1h; 144A.01; 144A.03, subdivision 1; 144A.04,
subdivisions 4, 6; 144A.06; 144A.4799, subdivisions 1, 3; 144A.75, subdivision
12; 144G.08, by adding a subdivision; 144G.15; 144G.17; 144G.19, by adding a
subdivision; 144G.20, subdivisions 1, 4, 5, 8, 9, 12, 15; 144G.30, subdivision 5;
144G.31, subdivisions 4, 8; 144G.41, subdivisions 7, 8; 144G.42, subdivision 10;
144G.50, subdivision 2; 144G.52, subdivisions 2, 8, 9; 144G.53; 144G.55,
subdivisions 1, 3; 144G.56, subdivisions 3, 5; 144G.57, subdivisions 1, 3, 5;
144G.70, subdivisions 2, 4; 144G.80, subdivision 2; 144G.90, subdivision 1, by
adding a subdivision; 144G.91, subdivisions 13, 21; 144G.92, subdivision 1;
144G.93; 144G.95; 145.4716, by adding a subdivision; 145.56, by adding
subdivisions; 145.924; 145A.131, subdivisions 1, 5; 145A.14, by adding a
subdivision; 146B.04, subdivision 1; 148B.33, by adding a subdivision; 148E.100,
subdivision 3; 148E.105, subdivision 3; 148E.106, subdivision 3; 148E.110,
subdivision 7; 149A.01, subdivisions 2, 3; 149A.02, subdivision 13a, by adding
subdivisions; 149A.03; 149A.09; 149A.11; 149A.60; 149A.61, subdivisions 4, 5;
149A.62; 149A.63; 149A.65, subdivision 2; 149A.70, subdivisions 3, 4, 5, 7;
149A.90, subdivisions 2, 4, 5; 149A.94, subdivision 1; 150A.06, subdivisions 1c,
2c, 6, by adding a subdivision; 150A.09; 150A.091, subdivisions 2, 5, 8, 9, by
adding subdivisions; 151.01, subdivisions 23, 27, by adding subdivisions; 151.071,
subdivisions 1, 2; 151.37, by adding a subdivision; 151.555, as amended; 151.72,
subdivisions 1, 2, 3, 4, 6, by adding a subdivision; 152.01, subdivision 23; 152.02,
subdivisions 2, 3; 152.11, by adding a subdivision; 152.12, by adding a subdivision;
152.125; 152.22, subdivision 8, by adding subdivisions; 152.25, subdivision 1, by
adding a subdivision; 152.29, subdivisions 3a, 4, by adding a subdivision; 152.30;
152.32; 152.33, subdivision 1; 152.35; 152.36; 153.16, subdivision 1; 169A.70,
subdivisions 3, 4; 177.27, subdivisions 4, 7; 242.19, subdivision 2; 245.462,
subdivision 4; 245.4882, by adding subdivisions; 245.4889, by adding a
subdivision; 245.713, subdivision 2; 245A.02, subdivision 5a; 245A.04, subdivision
4, by adding a subdivision; 245A.07, subdivisions 2a, 3; 245A.14, subdivision 14;
245A.1435; 245A.1443; 245A.146, subdivision 3; 245A.16, subdivision 1;
245D.10, subdivision 3a; 245D.12; 245F.03; 245F.15, subdivision 1; 245F.16,
subdivision 1; 245G.01, subdivisions 4, 17; 245G.05, subdivision 2; 245G.06,
subdivision 3, by adding subdivisions; 245G.08, subdivision 5; 245G.09,
subdivision 3; 245G.11, subdivisions 1, 10; 245G.13, subdivision 1; 245G.20;
245G.22, subdivisions 2, 7, 15; 245H.05; 245H.08, by adding a subdivision;
253B.18, subdivision 6; 254A.19, subdivisions 1, 3, by adding subdivisions;
254B.01, subdivision 5, by adding subdivisions; 254B.03, subdivisions 1, 4, 5;
254B.04, subdivision 2a, by adding subdivisions; 256.01, by adding subdivisions;
256.042, subdivisions 1, 2, 5; 256.043, subdivision 1, by adding a subdivision;
256.045, subdivision 3; 256.969, by adding a subdivision; 256B.021, subdivision
4; 256B.055, subdivisions 2, 17; 256B.056, subdivisions 3, 3b, 3c, 4, 7, 11;
256B.0595, subdivision 1; 256B.0625, subdivisions 13f, 17a, 18h, 22, 28b, 64, by
adding subdivisions; 256B.0631, as amended; 256B.0651, subdivisions 1, 2;
256B.0652, subdivision 11; 256B.0653, subdivision 6; 256B.0659, subdivisions
1, 12, 19, 24; 256B.0757, subdivision 5; 256B.0913, subdivisions 4, 5; 256B.092,
by adding a subdivision; 256B.0941, subdivision 3, by adding subdivisions;
256B.0946, subdivision 7; 256B.0949, subdivision 15; 256B.49, by adding a
subdivision; 256B.4911, by adding a subdivision; 256B.4914, subdivisions 8, as
amended, 9, as amended; 256B.69, subdivisions 4, 5c, 28, 36; 256B.692,
subdivision 1; 256B.6925, subdivisions 1, 2; 256B.6928, subdivision 3; 256B.76,
subdivision 1; 256B.77, subdivision 13; 256B.85, by adding a subdivision; 256D.03,
by adding a subdivision; 256D.0515; 256D.0516, subdivision 2; 256D.06,
subdivisions 1, 2, 5; 256D.09, subdivision 2a; 256E.33, subdivisions 1, 2; 256E.36,
subdivision 1; 256I.03, subdivisions 7, 13; 256I.04, subdivision 3; 256I.06,
subdivision 6; 256I.09; 256J.08, subdivisions 71, 79; 256J.21, subdivision 4;
256J.33, subdivision 2; 256J.37, subdivisions 3, 3a; 256J.95, subdivision 19;
256K.26, subdivisions 2, 6, 7; 256K.45, subdivision 3, by adding a subdivision;
256L.03, subdivision 5; 256L.04, subdivisions 1c, 7a, by adding a subdivision;
256L.12, subdivision 8; 256P.01, by adding a subdivision; 256P.04, subdivision
11; 256P.07, subdivisions 1, 2, 3, 4, 6, 7, by adding subdivisions; 256Q.06, by
adding a subdivision; 256R.02, subdivisions 4, 17, 18, 19, 22, 29, 42a, 48a, by
adding subdivisions; 256R.07, subdivisions 1, 2, 3; 256R.08, subdivision 1;
256R.09, subdivisions 2, 5; 256R.13, subdivision 4; 256R.16, subdivision 1;
256R.17, subdivision 3; 256R.26, subdivision 1; 256R.261, subdivision 13;
256R.37; 256R.39; 256S.15, subdivision 2; 256S.16; 256S.18, subdivision 1, by
adding a subdivision; 256S.19, subdivision 3; 256S.211, by adding subdivisions;
256S.212; 256S.213; 256S.214; 256S.215; 260.012; 260.761, subdivision 2;
260B.157, subdivisions 1, 3; 260B.331, subdivision 1; 260C.001, subdivision 3;
260C.007, subdivision 27; 260C.151, subdivision 6; 260C.152, subdivision 5;
260C.175, subdivision 2; 260C.176, subdivision 2; 260C.178, subdivision 1;
260C.181, subdivision 2; 260C.193, subdivision 3; 260C.201, subdivisions 1, 2;
260C.202; 260C.203; 260C.204; 260C.221; 260C.331, subdivision 1; 260C.451,
subdivision 8, by adding subdivisions; 260C.513; 260C.607, subdivisions 2, 5;
260C.613, subdivisions 1, 5; 260E.01; 260E.02, subdivision 1; 260E.03, by adding
subdivisions; 260E.14, subdivisions 2, 5; 260E.17, subdivision 1; 260E.18; 260E.20,
subdivision 1; 260E.22, subdivision 2; 260E.24, subdivisions 2, 7; 260E.33,
subdivision 1; 260E.34; 260E.35, subdivision 6; 268.19, subdivision 1; 299A.299,
subdivision 1; 518A.43, subdivision 1; 626.557, subdivisions 4, 9, 9b, 9c, 9d, 10,
10b, 12b; 626.5571, subdivisions 1, 2; 626.5572, subdivisions 2, 4, 17; Minnesota
Statutes 2021 Supplement, sections 16A.151, subdivision 2; 62A.673, subdivision
2; 62J.497, subdivisions 1, 3; 62J.84, subdivisions 6, 9; 119B.03, subdivision 4a;
119B.13, subdivision 1; 144.0724, subdivision 4; 144.1481, subdivision 1;
144.1501, subdivisions 1, 2, 3; 144.551, subdivision 1; 144.9501, subdivision 17;
148B.5301, subdivision 2; 148F.11, subdivision 1; 151.066, subdivision 3; 151.335;
151.72, subdivision 5; 152.27, subdivision 2; 152.29, subdivisions 1, 3; 245.467,
subdivisions 2, 3; 245.4871, subdivision 21; 245.4876, subdivisions 2, 3; 245.4885,
subdivision 1; 245.4889, subdivision 1; 245.735, subdivision 3; 245A.03,
subdivision 7; 245A.043, subdivision 3; 245A.14, subdivision 4; 245I.02,
subdivisions 19, 36; 245I.03, subdivision 9; 245I.04, subdivision 4; 245I.05,
subdivision 3; 245I.08, subdivision 4; 245I.09, subdivision 2; 245I.10, subdivisions
2, 6; 245I.20, subdivision 5; 245I.23, subdivision 22, by adding a subdivision;
254A.03, subdivision 3; 254A.19, subdivision 4; 254B.03, subdivision 2; 254B.04,
subdivision 1; 254B.05, subdivisions 1a, 4, 5; 256.01, subdivision 42; 256.042,
subdivision 4; 256.043, subdivisions 3, 4; 256B.0371, subdivision 4; 256B.04,
subdivision 14; 256B.0622, subdivision 2; 256B.0625, subdivisions 3b, 5m, 9, as
amended, 13, 17, 30, 31; 256B.0671, subdivision 6; 256B.0759, subdivision 4;
256B.0911, subdivision 3a; 256B.0946, subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947,
subdivisions 2, 3, 5, 6; 256B.0949, subdivisions 2, 13; 256B.85, subdivisions 7,
8; 256B.851, subdivision 5; 256I.06, subdivision 8; 256J.21, subdivision 3; 256J.33,
subdivision 1; 256L.03, subdivision 2; 256L.07, subdivision 1; 256L.15, subdivision
2; 256P.01, subdivision 6a; 256P.04, subdivisions 4, 8; 256P.06, subdivision 3;
256S.21; 256S.2101, subdivision 2, by adding a subdivision; 260C.007, subdivision
14; 260C.157, subdivision 3; 260C.212, subdivisions 1, 2; 260C.605, subdivision
1; 260C.607, subdivision 6; 260E.03, subdivision 22; 260E.20, subdivision 2;
363A.50; Laws 2009, chapter 79, article 13, section 3, subdivision 10, as amended;
Laws 2015, chapter 71, article 14, section 2, subdivision 5, as amended; Laws
2019, chapter 63, article 3, section 1, as amended; Laws 2020, First Special Session
chapter 7, section 1, subdivisions 1, as amended, 5, as amended; Laws 2021, First
Special Session chapter 2, article 1, section 4, subdivision 2; Laws 2021, First
Special Session chapter 7, article 1, section 36; article 3, section 44; article 14,
section 21, subdivision 4; article 16, sections 2, subdivisions 29, 31, 33; 12; article
17, sections 1, subdivision 2; 3; 6; 10; 11; 12; 14, subdivision 3; 17, subdivision
3; 19; Laws 2021, First Special Session chapter 8, article 6, section 1, subdivision
7; Laws 2022, chapter 33, section 1, subdivisions 5a, 9a; Laws 2022, chapter 40,
section 7; proposing coding for new law in Minnesota Statutes, chapters 3; 62A;
62J; 62Q; 62W; 115; 119B; 144; 144A; 145; 149A; 152; 181; 245; 245A; 256B;
256E; 256P; repealing Minnesota Statutes 2020, sections 119B.03, subdivision 4;
150A.091, subdivisions 3, 15, 17; 169A.70, subdivision 6; 245A.03, subdivision
5; 245F.15, subdivision 2; 245G.11, subdivision 2; 245G.22, subdivision 19;
246.0136; 252.025, subdivision 7; 252.035; 254A.02, subdivision 8a; 254A.04;
254A.16, subdivision 6; 254A.19, subdivisions 1a, 2; 254B.04, subdivisions 2b,
2c; 254B.041, subdivision 2; 254B.14, subdivisions 1, 2, 3, 4, 6; 256B.057,
subdivision 7; 256B.063; 256B.69, subdivision 20; 256D.055; 256J.08, subdivisions
10, 61, 62, 81, 83; 256J.30, subdivisions 5, 7; 256J.33, subdivisions 3, 5; 256J.34,
subdivisions 1, 2, 3, 4; 256J.37, subdivision 10; 256R.08, subdivision 2; 256R.49;
256S.19, subdivision 4; 501C.0408, subdivision 4; 501C.1206; Minnesota Statutes
2021 Supplement, sections 144G.07, subdivision 6; 254A.19, subdivision 5;
254B.14, subdivision 5; 256J.08, subdivision 53; 256J.30, subdivision 8; 256J.33,
subdivision 4; Minnesota Rules, parts 2960.0460, subpart 2; 9530.6565, subpart
2; 9530.7000, subparts 1, 2, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 17a, 19, 20, 21;
9530.7005; 9530.7010; 9530.7012; 9530.7015, subparts 1, 2a, 4, 5, 6; 9530.7020,
subparts 1, 1a, 2; 9530.7021; 9530.7022, subpart 1; 9530.7025; 9530.7030, subpart
1; 9555.6255.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
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(a) Each health provider and health facility shall comply
with Division BB, Title I of the Consolidated Appropriations Act, 2021, also known as the
"No Surprises Act," including any federal regulations adopted under that act, to the extent
that it imposes requirements that apply in this state but are not required under the laws of
this state. This section does not require compliance with any provision of the No Surprises
Act before January 1, 2022.
new text end
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(b) For the purposes of this section, "provider" or "facility" means any health care
provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that
is subject to relevant provisions of the No Surprises Act.
new text end
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(a) The commissioner of health shall, to the
extent practicable, seek the cooperation of health care providers and facilities in obtaining
compliance with this section.
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(b) A person who believes a health care provider or facility has not complied with the
requirements of the No Surprises Act or this section may file a complaint with the
commissioner of health. Complaints filed under this section must be filed in writing, either
on paper or electronically. The commissioner may prescribe additional procedures for the
filing of complaints.
new text end
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(c) The commissioner may also conduct compliance reviews to determine whether health
care providers and facilities are complying with this section.
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(d) The commissioner shall investigate complaints filed under this section. The
commissioner may prioritize complaint investigations, compliance reviews, and the collection
of any possible civil monetary penalties under paragraph (g), clause (2), based on factors
such as repeat complaints or violations, the seriousness of the complaint or violation, and
other factors as determined by the commissioner.
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(e) The commissioner shall inform the health care provider or facility of the complaint
or findings of a compliance review and shall provide an opportunity for the health care
provider or facility to submit information the health care provider or facility considers
relevant to further review and investigation of the complaint or the findings of the compliance
review. The health care provider or facility must submit any such information to the
commissioner within 30 days of receipt of notification of a complaint or compliance review
under this section.
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(f) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility has not violated this
section, the commissioner shall notify the provider or facility as well as any relevant
complainant.
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(g) If, after reviewing any information described in paragraph (e) and the results of any
investigation, the commissioner determines that the provider or facility is in violation of
this section, the commissioner shall notify the provider or facility and take the following
steps:
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(1) in cases of noncompliance with this section, the commissioner shall first attempt to
achieve compliance through successful remediation on the part of the noncompliant provider
or facility including completion of a corrective action plan or other agreement; and
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(2) if, after taking the action in clause (1) compliance has not been achieved, the
commissioner of health shall notify the provider or facility that the provider or facility is in
violation of this section and that the commissioner is imposing a civil monetary penalty. If
the commissioner determines that more than one health care provider or facility was
responsible for a violation, the commissioner may impose a civil money penalty against
each health care provider or facility. The amount of a civil money penalty shall be up to
$100 for each violation, but shall not exceed $25,000 for identical violations during a
calendar year; and
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(3) no civil money penalty shall be imposed under this section for violations that occur
prior to January 1, 2023. Warnings must be issued and any compliance issues must be
referred to the federal government for enforcement pursuant to the federal No Surprises Act
or other applicable federal laws and regulations.
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(h) A health care provider or facility may contest whether the finding of facts constitute
a violation of this section according to the contested case proceeding in sections 14.57 to
14.62, subject to appeal according to sections 14.63 to 14.68.
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(i) When steps in paragraphs (b) to (h) have been completed as needed, the commissioner
shall notify the health care provider or facility and, if the matter arose from a complaint,
the complainant regarding the disposition of complaint or compliance review.
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(j) Civil money penalties imposed and collected under this subdivision shall be deposited
into the general fund and are appropriated to the commissioner of health for the purposes
of this section, including the provision of compliance reviews and technical assistance.
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(k) Any compliance and investigative action taken by the department under this section
shall only include potential violations that occur on or after the effective date of this section.
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This section is effective the day following final enactment.
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Minnesota Statutes 2020, section 62Q.021, is amended by adding a subdivision to
read:
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Each health plan company, health provider,
and health facility shall comply with Division BB, Title I of the Consolidated Appropriations
Act, 2021, also known as the "No Surprises Act," including any federal regulations adopted
under that act, to the extent that it imposes requirements that apply in this state but are not
required under the laws of this state. This section does not require compliance with any
provision of the No Surprises Act before the effective date provided for that provision in
the Consolidated Appropriations Act. The commissioner shall enforce this subdivision.
new text end
Minnesota Statutes 2020, section 62Q.55, subdivision 5, is amended to read:
If emergency services are provided by
a nonparticipating provider, with or without prior authorization, the health plan company
shall not impose coverage restrictions or limitations that are more restrictive than apply to
emergency services received from a participating provider. Cost-sharing requirements that
apply to emergency services received out-of-network must be the same as the cost-sharing
requirements that apply to services received in-networknew text begin and shall count toward the in-network
deductible. All coverage and charges for emergency services must comply with all
requirements of Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that actnew text end .
Minnesota Statutes 2020, section 62Q.556, is amended to read:
(a) Except as provided in paragraph deleted text begin (c)deleted text end new text begin (b)new text end , deleted text begin unauthorized provider
services occurdeleted text end new text begin balance billing is prohibitednew text end when an enrollee receives services:
(1) from a nonparticipating provider at a participating hospital or ambulatory surgical
center, deleted text begin when the services are rendered:deleted text end new text begin as described by Division BB, Title I of the
Consolidated Appropriations Act, 2021, including any federal regulations adopted under
that act;
new text end
deleted text begin
(i) due to the unavailability of a participating provider;
deleted text end
deleted text begin
(ii) by a nonparticipating provider without the enrollee's knowledge; or
deleted text end
deleted text begin
(iii) due to the need for unforeseen services arising at the time the services are being
rendered; or
deleted text end
(2) from a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facilitydeleted text begin .deleted text end new text begin ; or
new text end
deleted text begin
(b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.
deleted text end
new text begin
(3) from a nonparticipating provider or facility providing emergency services as defined
in section 62Q.55, subdivision 3, and other services as described in the requirements of
Division BB, Title I of the Consolidated Appropriations Act, 2021, including any federal
regulations adopted under that act.
new text end
deleted text begin (c)deleted text end new text begin (b)new text end The services described in paragraph (a), deleted text begin clausedeleted text end new text begin clauses (1) andnew text end (2), new text begin as defined in
Division BB, Title I of the Consolidated Appropriations Act, 2021, and any federal
regulations adopted under that act, new text end are deleted text begin not unauthorized provider servicesdeleted text end new text begin subject to balance
billingnew text end if the enrollee gives deleted text begin advance writtendeleted text end new text begin informednew text end consent deleted text begin to thedeleted text end new text begin prior to receiving
services from the nonparticipatingnew text end provider acknowledging that the use of a provider, or
the services to be rendered, may result in costs not covered by the health plan.new text begin The informed
consent must comply with all requirements of Division BB, Title I of the Consolidated
Appropriations Act, 2021, including any federal regulations adopted under that act.
new text end
(a) An enrollee's financial responsibility for the deleted text begin unauthorizeddeleted text end new text begin nonparticipatingnew text end
provider services new text begin described in subdivision 1, paragraph (a), new text end shall be the same cost-sharing
requirements, including co-payments, deductibles, coinsurance, coverage restrictions, and
coverage limitations, as those applicable to services received by the enrollee from a
participating provider. A health plan company must apply any enrollee cost sharing
requirements, including co-payments, deductibles, and coinsurance, for unauthorized provider
services to the enrollee's annual out-of-pocket limit to the same extent payments to a
participating provider would be applied.
(b) A health plan company deleted text begin must attempt to negotiate the reimbursement, less any
applicable enrollee cost sharing under paragraph (a), for the unauthorized provider services
with the nonparticipating provider. If a health plan company's and nonparticipating provider's
attempts to negotiate reimbursement for the health care services do not result in a resolution,
the health plan company or provider may elect to refer the matter for binding arbitration,
chosen in accordance with paragraph (c). A nondisclosure agreement must be executed by
both parties prior to engaging an arbitrator in accordance with this section. The cost of
arbitration must be shared equally between the partiesdeleted text end new text begin and nonparticipating provider shall
initiate open negotiations of disputed amounts. If there is no agreement, either party may
initiate the federal independent dispute resolution process pursuant to Division BB, Title I
of the Consolidated Appropriations Act, 2021, including any federal regulations adopted
under that actnew text end .
deleted text begin
(c) The commissioner of health, in consultation with the commissioner of the Bureau
of Mediation Services, must develop a list of professionals qualified in arbitration, for the
purpose of resolving disputes between a health plan company and nonparticipating provider
arising from the payment for unauthorized provider services. The commissioner of health
shall publish the list on the Department of Health website, and update the list as appropriate.
deleted text end
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(d) The arbitrator must consider relevant information, including the health plan company's
payments to other nonparticipating providers for the same services, the circumstances and
complexity of the particular case, and the usual and customary rate for the service based on
information available in a database in a national, independent, not-for-profit corporation,
and similar fees received by the provider for the same services from other health plans in
which the provider is nonparticipating, in reaching a decision.
deleted text end
new text begin
(a) Beginning April 1, 2023, a health plan company
must report annually to the commissioner:
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(1) the total number of claims and total billed and paid amount for nonparticipating
provider services, by service and provider type, submitted to the health plan in the prior
calendar year; and
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(2) the total number of enrollee complaints received regarding the rights and protections
established by Division BB, Title I of the Consolidated Appropriations Act, 2021, including
any federal regulations adopted under that act, in the prior calendar year.
new text end
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(b) The commissioners of commerce and health may develop the form and manner for
health plan companies to comply with paragraph (a).
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(a) Any provider or facility, including a health care provider or
facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject
to relevant provisions of the No Surprises Act is subject to the requirements of this section.
new text end
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(b) The commissioner of commerce or health may enforce this section.
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(c) If the commissioner of health has cause to believe that any hospital or facility licensed
under chapter 144 has violated this section, the commissioner may investigate, examine,
and otherwise enforce this section pursuant to chapter 144 or may refer the potential violation
to the relevant licensing board with regulatory authority over the provider.
new text end
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(d) If a health-related licensing board has cause to believe that a provider has violated
this section, it may further investigate and enforce the provisions of this section pursuant
to chapter 214.
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Minnesota Statutes 2020, section 62Q.56, subdivision 2, is amended to read:
(a) If an enrollee is subject to a change in health plans,
the enrollee's new health plan company must provide, upon request, authorization to receive
services that are otherwise covered under the terms of the new health plan through the
enrollee's current provider:
(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one
or more of the following conditions:
(i) an acute condition;
(ii) a life-threatening mental or physical illness;
(iii) pregnancy deleted text begin beyond the first trimester of pregnancydeleted text end ;
(iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided that the disability has lasted or can be expected to last for at least
one year, or can be expected to result in death; or
(v) a disabling or chronic condition that is in an acute phase; or
(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
For all requests for authorization under this paragraph, the health plan company must grant
the request for authorization unless the enrollee does not meet the criteria provided in this
paragraph.
(b) The health plan company shall prepare a written plan that provides a process for
coverage determinations regarding continuity of care of up to 120 days for new enrollees
who request continuity of care with their former provider, if the new enrollee:
(1) is receiving culturally appropriate services and the health plan company does not
have a provider in its preferred provider network with special expertise in the delivery of
those culturally appropriate services within the time and distance requirements of section
62D.124, subdivision 1; or
(2) does not speak English and the health plan company does not have a provider in its
preferred provider network who can communicate with the enrollee, either directly or through
an interpreter, within the time and distance requirements of section 62D.124, subdivision
1.
The written plan must explain the criteria that will be used to determine whether a need for
continuity of care exists and how it will be provided.
(c) This subdivision applies only to group coverage and continuation and conversion
coverage, and applies only to changes in health plans made by the employer.
Minnesota Statutes 2020, section 62Q.73, subdivision 7, is amended to read:
(a) For an external review of any issue in an adverse
determination that does not require a medical necessity determination, the external review
must be based on whether the adverse determination was in compliance with the enrollee's
health benefit plannew text begin and any applicable state and federal lawnew text end .
(b) For an external review of any issue in an adverse determination by a health plan
company licensed under chapter 62D that requires a medical necessity determination, the
external review must determine whether the adverse determination was consistent with the
definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
(c) For an external review of any issue in an adverse determination by a health plan
company, other than a health plan company licensed under chapter 62D, that requires a
medical necessity determination, the external review must determine whether the adverse
determination was consistent with the definition of medically necessary care in section
62Q.53, subdivision 2.
(d) Fo