SF 953

1st Engrossment - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act  
  1.2             relating to health; providing for certain patient 
  1.3             rights and protections; regulating coverages and the 
  1.4             classification of treatment; specifying the duties of 
  1.5             certain carriers and providers; providing remedies; 
  1.6             amending Minnesota Statutes 1998, sections 62A.60; 
  1.7             62J.71, subdivisions 1 and 3; 62J.72, by adding a 
  1.8             subdivision; 62J.80; 62M.05, subdivision 3; 62M.09, 
  1.9             subdivisions 2, 3, 6, and by adding a subdivision; 
  1.10            62M.10, subdivision 7; 62Q.58, subdivision 3; 144.335, 
  1.11            by adding a subdivision; and 147.081, subdivision 3; 
  1.12            proposing coding for new law in Minnesota Statutes, 
  1.13            chapter 62Q; proposing coding for new law as Minnesota 
  1.14            Statutes, chapter 62U. 
  1.15  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.16     Section 1.  Minnesota Statutes 1998, section 62A.60, is 
  1.17  amended to read: 
  1.18     62A.60 [RETROACTIVE DENIAL OF EXPENSES.] 
  1.19     In cases where the subscriber or insured is liable for 
  1.20  costs beyond applicable copayments or deductibles, no insurer 
  1.21  may retroactively deny payment to a person who is covered when 
  1.22  the services are provided for health care services that are 
  1.23  otherwise covered, if the insurer or its representative failed 
  1.24  to provide prior or concurrent review or authorization for the 
  1.25  expenses when required to do so under the policy, plan, or 
  1.26  certificate.  If prior or concurrent review or authorization was 
  1.27  provided by the insurer or its representative, and the 
  1.28  preexisting condition limitation provision, the general 
  1.29  exclusion provision and any other coinsurance, or other policy 
  1.30  requirements have been met, the insurer may not deny payment for 
  2.1   the authorized service or time period except in cases where 
  2.2   fraud or substantive misrepresentation occurred.  A health 
  2.3   carrier that has given preauthorization approval for a service 
  2.4   or treatment may not subsequently deny payment for that service 
  2.5   or treatment on the grounds that the service or treatment is not 
  2.6   covered by the health plan.  At the time a decision regarding 
  2.7   the medical necessity of a service or treatment is communicated 
  2.8   to an enrollee in accordance with section 62M.05, a health 
  2.9   carrier shall also communicate whether the requested service or 
  2.10  treatment is a covered benefit. 
  2.11     Sec. 2.  Minnesota Statutes 1998, section 62J.71, 
  2.12  subdivision 1, is amended to read: 
  2.13     Subdivision 1.  [PROHIBITED AGREEMENTS AND DIRECTIVES.] The 
  2.14  following types of agreements and directives are contrary to 
  2.15  state public policy, are prohibited under this section, and are 
  2.16  null and void: 
  2.17     (1) any agreement or directive that prohibits a health care 
  2.18  provider from communicating with an enrollee with respect to the 
  2.19  enrollee's health status, health care, or treatment options, if 
  2.20  the health care provider is acting in good faith and within the 
  2.21  provider's scope of practice as defined by law; 
  2.22     (2) any agreement or directive that prohibits a health care 
  2.23  provider from making a recommendation regarding the suitability 
  2.24  or desirability of a health plan company, health insurer, or 
  2.25  health coverage plan for an enrollee, unless the provider has a 
  2.26  financial conflict of interest in the enrollee's choice of 
  2.27  health plan company, health insurer, or health coverage plan; 
  2.28     (3) any agreement or directive that prohibits a provider 
  2.29  from providing testimony, supporting or opposing legislation, or 
  2.30  making any other contact with state or federal legislators or 
  2.31  legislative staff or with state and federal executive branch 
  2.32  officers or staff; 
  2.33     (4) any agreement or directive that prohibits a health care 
  2.34  provider from disclosing accurate information about whether 
  2.35  services or treatment will be paid for by a patient's health 
  2.36  plan company or health insurer or health coverage plan; and 
  3.1      (5) any agreement or directive that prohibits a health care 
  3.2   provider from informing an enrollee about the nature of the 
  3.3   reimbursement methodology used by an enrollee's health plan 
  3.4   company, health insurer, or health coverage plan to pay the 
  3.5   provider; and 
  3.6      (6) any agreement or directive that constitutes a physician 
  3.7   incentive plan prohibited under United States Code, title 42, 
  3.8   section 1395mm, paragraph (i), clause (8). 
  3.9      Sec. 3.  Minnesota Statutes 1998, section 62J.71, 
  3.10  subdivision 3, is amended to read: 
  3.11     Subd. 3.  [RETALIATION PROHIBITED.] No person, health plan 
  3.12  company, or other organization may take retaliatory action 
  3.13  against a health care provider solely on the grounds that the 
  3.14  provider: 
  3.15     (1) refused to enter into an agreement or provide services 
  3.16  or information in a manner that is prohibited under this section 
  3.17  or took any of the actions listed in subdivision 1; 
  3.18     (2) disclosed accurate information about whether a health 
  3.19  care service or treatment is covered by an enrollee's health 
  3.20  plan company, health insurer, or health coverage plan; 
  3.21     (3) discussed diagnostic, treatment, or referral options 
  3.22  that are not covered or are limited by the enrollee's health 
  3.23  plan company, health insurer, or health coverage plan; 
  3.24     (4) criticized coverage of the enrollee's health plan 
  3.25  company, health insurer, or health coverage plan; or 
  3.26     (5) expressed personal disagreement with a decision made by 
  3.27  a person, organization, or health care provider regarding 
  3.28  treatment or coverage provided to a patient of the provider, or 
  3.29  assisted or advocated for the patient in seeking reconsideration 
  3.30  of such a decision, provided the health care provider makes it 
  3.31  clear that the provider is acting in a personal capacity and not 
  3.32  as a representative of or on behalf of the entity that made the 
  3.33  decision; 
  3.34     (6) discloses information relating to the care, services, 
  3.35  or conditions affecting an enrollee to an appropriate public 
  3.36  regulatory agency, private accreditation body, or management 
  4.1   personnel of the health plan company; or 
  4.2      (7) initiates, cooperates, or otherwise participates in a 
  4.3   utilization review under chapter 62M or in an investigation or 
  4.4   proceeding by a public regulatory agency. 
  4.5      Sec. 4.  Minnesota Statutes 1998, section 62J.72, is 
  4.6   amended by adding a subdivision to read: 
  4.7      Subd. 1a.  [DISCLOSURE OF COVERAGE AGREEMENT OR SUBSCRIBER 
  4.8   CONTRACT.] A health plan company shall, upon request, provide to 
  4.9   a prospective enrollee a specimen copy of the actual certificate 
  4.10  or other evidence of coverage required to be filed with the 
  4.11  commissioner of commerce or commissioner of health under chapter 
  4.12  62A, 62C, or 62D. 
  4.13     Sec. 5.  Minnesota Statutes 1998, section 62J.80, is 
  4.14  amended to read: 
  4.15     62J.80 [RETALIATION.] 
  4.16     A health plan company or health care provider shall not 
  4.17  retaliate or take adverse action against an enrollee or, 
  4.18  patient, or health care provider who, in good faith, makes a 
  4.19  complaint against a health plan company or health care 
  4.20  provider or who participates in a utilization review under 
  4.21  chapter 62M.  If retaliation is suspected, the executive 
  4.22  director of a health-related licensing board as defined in 
  4.23  section 214.01, subdivision 2, may report it to the appropriate 
  4.24  regulatory authority.  
  4.25     Sec. 6.  Minnesota Statutes 1998, section 62M.05, 
  4.26  subdivision 3, is amended to read: 
  4.27     Subd. 3.  [NOTIFICATION OF DETERMINATIONS.] A utilization 
  4.28  review organization must have written procedures for providing 
  4.29  notification of its determinations on all certifications in 
  4.30  accordance with the following: 
  4.31     (a) When an initial determination is made to certify, 
  4.32  notification must be provided promptly by telephone to the 
  4.33  provider according to paragraph (c).  The utilization review 
  4.34  organization shall send written notification to the hospital, 
  4.35  attending physician, or applicable service provider within ten 
  4.36  business days of the determination in accordance with section 
  5.1   72A.201, subdivision 4a, or and the enrollee according to 
  5.2   paragraph (c).  The utilization review organization shall 
  5.3   maintain an audit trail of the determination and telephone 
  5.4   notification.  For purposes of this subdivision, "audit trail" 
  5.5   includes documentation of the telephone notification, including 
  5.6   the date; the name of the person spoken to; the enrollee or 
  5.7   patient; the service, procedure, or admission certified; and the 
  5.8   date of the service, procedure, or admission.  If the 
  5.9   utilization review organization indicates certification by use 
  5.10  of a number, the number must be called the "certification 
  5.11  number." 
  5.12     (b) When a determination is made not to certify a hospital 
  5.13  or surgical facility admission or extension of a hospital stay, 
  5.14  or other service requiring review determination, within one 
  5.15  working day after making the decision the attending physician 
  5.16  and hospital must be notified by telephone and a written 
  5.17  notification must be sent to the hospital, attending physician, 
  5.18  and enrollee or patient.  The written notification must include 
  5.19  the principal reason or reasons for the determination and the 
  5.20  process for initiating an appeal of the determination.  Upon 
  5.21  request, the utilization review organization shall provide the 
  5.22  attending physician or, provider, enrollee, or patient with the 
  5.23  criteria used to determine the necessity, appropriateness, and 
  5.24  efficacy of the health care service and identify the database, 
  5.25  professional treatment parameter, or other basis for the 
  5.26  criteria.  Reasons for a determination not to certify may 
  5.27  include, among other things, the lack of adequate information to 
  5.28  certify after a reasonable attempt has been made to contact the 
  5.29  attending physician. 
  5.30     (c) When an initial determination is made to certify, the 
  5.31  utilization review organization shall provide notice according 
  5.32  to this paragraph: 
  5.33     (1) In the case of utilization review involving prior 
  5.34  authorization of services, the utilization review organization 
  5.35  shall provide notice as soon as possible according to medical 
  5.36  exigencies of the case and in no event later than three business 
  6.1   days after the date of receipt of information that is necessary 
  6.2   to make the determination. 
  6.3      (2) In the case of a utilization review involving 
  6.4   authorization for continued or extended health care services or 
  6.5   additional services for an enrollee undergoing a course of 
  6.6   continued treatment prescribed by the attending physician, the 
  6.7   utilization review organization shall provide notice as soon as 
  6.8   possible according to medical exigencies of the case and in no 
  6.9   event later than one business day after the date of receipt of 
  6.10  information that is necessary to make the determination.  
  6.11  Notification regarding continued or extended health care 
  6.12  services must specify the number of extended services approved, 
  6.13  the new total of approved services, the date of onset of 
  6.14  services, and the new review date, if any. 
  6.15     (3) In the case of a utilization review involving 
  6.16  retrospective review of health care services previously 
  6.17  provided, the utilization review organization shall provide 
  6.18  notice within 30 days of the date of receipt of information that 
  6.19  is necessary to make the determination.  
  6.20     Sec. 7.  Minnesota Statutes 1998, section 62M.09, 
  6.21  subdivision 2, is amended to read: 
  6.22     Subd. 2.  [LICENSURE REQUIREMENT.] Except as provided under 
  6.23  subdivision 3, nurses, physicians, and other licensed health 
  6.24  professionals conducting reviews of medical services, and other 
  6.25  clinical reviewers conducting specialized reviews in their area 
  6.26  of specialty must be currently licensed or certified by an 
  6.27  approved state licensing agency in the United States. 
  6.28     Sec. 8.  Minnesota Statutes 1998, section 62M.09, 
  6.29  subdivision 3, is amended to read: 
  6.30     Subd. 3.  [PHYSICIAN REVIEWER INVOLVEMENT.] A physician 
  6.31  must review all cases in which the utilization review 
  6.32  organization has concluded that a determination not to certify 
  6.33  for clinical reasons is appropriate.  The physician conducting 
  6.34  the review must be licensed in the state and must be currently 
  6.35  practicing or have practiced in the same primary specialty as 
  6.36  the attending physician.  The physician should shall be 
  7.1   reasonably available by telephone to discuss the determination 
  7.2   with the attending physician, the enrollee, and the enrollee's 
  7.3   designee.  This subdivision does not apply to outpatient mental 
  7.4   health or substance abuse services governed by subdivision 3a.  
  7.5      Sec. 9.  Minnesota Statutes 1998, section 62M.09, 
  7.6   subdivision 6, is amended to read: 
  7.7      Subd. 6.  [PHYSICIAN CONSULTANTS.] A utilization review 
  7.8   organization must use physician consultants in the appeal 
  7.9   process described in section 62M.06, subdivision 3.  The 
  7.10  physician consultants should include, as needed and available, 
  7.11  specialists who are must be board-certified, or board-eligible 
  7.12  and working towards certification, in a specialty board approved 
  7.13  by the American Board of Medical Specialists or the American 
  7.14  Board of Osteopathy. 
  7.15     Sec. 10.  Minnesota Statutes 1998, section 62M.09, is 
  7.16  amended by adding a subdivision to read: 
  7.17     Subd. 9.  [ANNUAL REPORT.] A utilization review 
  7.18  organization shall file an annual report with the commissioner 
  7.19  of commerce that includes: 
  7.20     (1) the number and rate of denied claims for each procedure 
  7.21  or service; and 
  7.22     (2) the number and rate of denials overturned on appeal. 
  7.23     Sec. 11.  Minnesota Statutes 1998, section 62M.10, 
  7.24  subdivision 7, is amended to read: 
  7.25     Subd. 7.  [AVAILABILITY OF CRITERIA.] Upon request, a 
  7.26  utilization review organization shall provide to an enrollee or 
  7.27  to, an attending physician or provider, and the commissioners of 
  7.28  commerce and health the criteria used for a specific procedure 
  7.29  to determine the medical necessity, appropriateness, and 
  7.30  efficacy of that a procedure or service and identify the 
  7.31  database, professional treatment guideline, or other basis for 
  7.32  the criteria. 
  7.33     Sec. 12.  [62Q.235] [CLASSIFICATION OF MEDICAL TREATMENT.] 
  7.34     Subdivision 1.  [EXPERIMENTAL OR INVESTIGATIVE 
  7.35  TREATMENT.] A health plan company may not classify a drug, 
  7.36  device, medical treatment, diagnostic procedure, or other 
  8.1   procedure that is recommended for an enrollee's use by a 
  8.2   licensed physician as "experimental" or "investigative" unless 
  8.3   the health plan company demonstrates that it is unsafe or 
  8.4   ineffective with respect to the health outcome of the enrollee 
  8.5   seeking the treatment.  In making a demonstration that a drug, 
  8.6   device, medical treatment, diagnostic procedure, or other 
  8.7   procedure is experimental or investigative, a health plan 
  8.8   company may not rely exclusively on a finding that the drug, 
  8.9   device, medical treatment, diagnostic procedure, or other 
  8.10  procedure is under study by medical providers or researchers. 
  8.11     Subd. 2.  [MEDICALLY NECESSARY TREATMENT.] For purposes of 
  8.12  coverage under a health plan, a service, treatment, or procedure 
  8.13  is considered "medically necessary" if the service, treatment, 
  8.14  or procedure is appropriate, in terms of type, frequency, level, 
  8.15  setting, and duration to the enrollee's diagnosis or condition 
  8.16  and is:  
  8.17     (1) consistent with generally accepted practice parameters 
  8.18  as determined by a practicing health care provider in the same 
  8.19  or similar general specialty that typically manages the 
  8.20  condition, treatment, or procedure at issue; and 
  8.21     (2) helps to restore, maintain, establish, or improve the 
  8.22  enrollee's health or function; or 
  8.23     (3) prevents deterioration of the enrollee's condition; or 
  8.24     (4) prevents the reasonably likely onset of a health 
  8.25  problem or detects an incipient problem. 
  8.26     Sec. 13.  Minnesota Statutes 1998, section 62Q.58, 
  8.27  subdivision 3, is amended to read: 
  8.28     Subd. 3.  [DISCLOSURE.] Information regarding referral 
  8.29  procedures, including the application process and criteria and 
  8.30  conditions for a standing referral to a health care provider who 
  8.31  is a specialist, must be included in member contracts or 
  8.32  certificates of coverage and must be provided to an enrollee or 
  8.33  prospective enrollee by a health plan company upon request. 
  8.34     Sec. 14.  [62Q.60] [COVERAGE FOR APPROVED CLINICAL TRIALS.] 
  8.35     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
  8.36  section, the terms defined in this subdivision have the meanings 
  9.1   given. 
  9.2      (b) "Approved clinical trial" means a clinical research 
  9.3   study or clinical investigation approved and funded by one or 
  9.4   more of the following: 
  9.5      (1) the National Institute of Health; 
  9.6      (2) a cooperative group or center of the National Institute 
  9.7   of Health; 
  9.8      (3) the United States Department of Veterans Affairs; or 
  9.9      (4) the United States Department of Defense. 
  9.10     (c) "Qualified enrollee" means an enrollee: 
  9.11     (1) who has a life-threatening or serious illness for which 
  9.12  no standard treatment is effective; 
  9.13     (2) who is eligible to participate in an approved clinical 
  9.14  trial according to the trial protocol with respect to treatment 
  9.15  of the illness; and 
  9.16     (3) whose participation in the approved clinical trial 
  9.17  offers meaningful potential for significant clinical benefit for 
  9.18  the enrollee. 
  9.19     (d) "Patient costs" means costs associated with benefits 
  9.20  that are covered under the enrollee's health plan and do not 
  9.21  include the cost of tests or measurements conducted primarily 
  9.22  for the purpose of the approved clinical trial involved. 
  9.23     Subd. 2.  [COVERAGE REQUIRED.] (a) A health plan company 
  9.24  that provides coverage to a qualified enrollee may not deny the 
  9.25  enrollee participation in an approved clinical trial if the 
  9.26  enrollee's referring physician is a participating provider in 
  9.27  the clinical trial and has concluded that the enrollee's 
  9.28  participation in the trial would be appropriate.  The health 
  9.29  plan company may not deny, limit, or impose additional 
  9.30  conditions on the coverage of patient costs for items and 
  9.31  services furnished in connection with the participation in the 
  9.32  approved clinical trial.  
  9.33     (b) The health plan company may not discriminate against 
  9.34  the enrollee on the basis of the enrollee's participation in the 
  9.35  approved clinical trial. 
  9.36     Subd. 3.  [PAYMENT.] A health plan company shall provide 
 10.1   for payment of routine patient costs but is not required to pay 
 10.2   for costs of items and services that are reasonably expected to 
 10.3   be paid by the sponsors of the approved clinical trial.  
 10.4      Subd. 4.  [CONSTRUCTION.] Nothing in this section shall be 
 10.5   construed to limit a health plan company's coverage with respect 
 10.6   to clinical trials.  
 10.7      Sec. 15.  [62U.01] [SHORT TITLE.] 
 10.8      This chapter may be cited as the "Health Care Liability 
 10.9   Act." 
 10.10     Sec. 16.  [62U.02] [DEFINITIONS.] 
 10.11     Subdivision 1.  [ENROLLEE.] "Enrollee" means an individual 
 10.12  who is covered by a health carrier, health insurance, or health 
 10.13  coverage plan, including an insured, policyholder, subscriber, 
 10.14  contract holder, member-covered person, or certificate holder. 
 10.15     Subd. 2.  [HEALTH PLAN.] "Health plan" means a policy or 
 10.16  certificate of accident and sickness insurance as defined in 
 10.17  section 62A.01 offered by an insurance company licensed under 
 10.18  chapter 60A; a subscriber contract or certificate offered by a 
 10.19  nonprofit health service plan corporation operating under 
 10.20  chapter 62C; a health maintenance contract or certificate 
 10.21  offered by a health maintenance organization operating under 
 10.22  chapter 62D; a health benefit certificate offered by a fraternal 
 10.23  benefit society operating under chapter 64B; or health coverage 
 10.24  offered by a joint self-insurance employee health plan operating 
 10.25  under chapter 62H.  Health plan means individual and group 
 10.26  coverage, unless otherwise specified.  
 10.27     Subd. 3.  [HEALTH CARE PROVIDER.] "Health care provider" or 
 10.28  "provider" means a person defined in section 144.335, 
 10.29  subdivision 1, paragraph (b).  
 10.30     Subd. 4.  [HEALTH CARE TREATMENT DECISION.] "Health care 
 10.31  treatment decision" means determinations or decisions made that 
 10.32  affect the quality of the diagnosis, care, or treatment provided 
 10.33  to the enrollees.  A health care treatment decision includes, 
 10.34  but is not limited to, a determination that a service, 
 10.35  treatment, or procedure is not medically necessary. 
 10.36     Subd. 5.  [HEALTH CARRIER.] "Health carrier" means an 
 11.1   insurance company licensed under chapter 60A to offer, sell, or 
 11.2   issue a policy of accident and sickness insurance as defined in 
 11.3   section 62A.01; a nonprofit health service plan corporation 
 11.4   operating under chapter 62C; a health maintenance organization 
 11.5   operating under chapter 62D; a joint self-insurance employee 
 11.6   health plan operating under chapter 62H; a community integrated 
 11.7   systems network licensed under chapter 62N; a fraternal benefit 
 11.8   society operating under chapter 64B; or an association, 
 11.9   partnership, corporation, or limited liability corporation 
 11.10  organized for the purpose of providing, arranging, or 
 11.11  administering health care services or treatment. 
 11.12     Subd. 6.  [MEDICALLY NECESSARY TREATMENT.] "Medically 
 11.13  necessary treatment" means services, treatment, or procedures 
 11.14  that are appropriate in terms of type, frequency, level, 
 11.15  setting, and duration of the enrollee's diagnosis or condition 
 11.16  and is: 
 11.17     (1) consistent with generally accepted practice parameters 
 11.18  as determined by a practicing health care provider in the same 
 11.19  or similar general specialty that typically manages the 
 11.20  condition, treatment, or procedure at issue; and 
 11.21     (2) helps to restore, maintain, establish, or improve the 
 11.22  enrollee's health or function; or 
 11.23     (3) prevents deterioration of the enrollee's condition; or 
 11.24     (4) prevents the reasonably likely onset of a health 
 11.25  problem or detects an incipient problem. 
 11.26     Subd. 7.  [ORDINARY CARE.] "Ordinary care" means, in the 
 11.27  case of a health carrier, that degree of care that a principled, 
 11.28  provident provider would exercise in a matter of the gravest 
 11.29  importance.  In the case of a person who is an employee, agent, 
 11.30  ostensible agent, or representative of a health carrier, 
 11.31  ordinary care means that degree of care that a person of 
 11.32  ordinary prudence in the same profession, specialty, or area of 
 11.33  practice would use in the same or similar circumstances. 
 11.34     Sec. 17.  [62U.03] [APPLICATION.] 
 11.35     Subdivision 1.  [DUTY OF ORDINARY CARE.] A health carrier 
 11.36  has the duty to exercise ordinary care when making health care 
 12.1   treatment decisions and is liable for damages to an enrollee for 
 12.2   harm proximately caused by its failure to exercise ordinary 
 12.3   care.  Damages awarded pursuant to this subdivision must not be 
 12.4   considered claims-related expenses. 
 12.5      Subd. 2.  [RESPONSIBILITY FOR ACTIONS OF OTHERS.] A health 
 12.6   carrier is also liable for damages to an enrollee for harm 
 12.7   proximately caused by a health care treatment decision made by 
 12.8   its: 
 12.9      (1) employees; 
 12.10     (2) agents; 
 12.11     (3) ostensible agents; or 
 12.12     (4) representatives who are acting on its behalf and over 
 12.13  whom it has the right to exercise influence or control or has 
 12.14  actually exercised influence or control that results in the 
 12.15  failure to exercise ordinary care. 
 12.16     In an action against a health carrier, a finding that a 
 12.17  health care provider is an employee, agent, ostensible agent, or 
 12.18  representative of the health carrier shall not be based solely 
 12.19  on proof that the person's name appears in a listing of approved 
 12.20  health care providers made available to enrollees under a health 
 12.21  plan. 
 12.22     Subd. 3.  [DEFENSES.] It shall be a defense to an action 
 12.23  asserted against a health carrier that: 
 12.24     (1) neither the health carrier, nor any employee, agent, 
 12.25  ostensible agent, or representative for whose conduct the health 
 12.26  carrier is liable under subdivision 2, controlled, influenced, 
 12.27  or participated in the health care treatment decision; and 
 12.28     (2) the health carrier did not deny or delay payment for 
 12.29  any service, treatment, or procedure prescribed or recommended 
 12.30  by a provider to the enrollee. 
 12.31     Subd. 4.  [LIMITATIONS.] (a) The standards in subdivisions 
 12.32  1 and 2 create no obligation on the part of the health carrier 
 12.33  to provide to an enrollee a service, treatment, or procedure 
 12.34  that is not covered by the health plan. 
 12.35     (b) This chapter does not create liability on the part of 
 12.36  an employer or an employer group purchasing organization that 
 13.1   purchases coverage or assumes risk on behalf of its employees. 
 13.2      Subd. 5.  [LIMITATION ON DEFENSES.] Nothing in any law of 
 13.3   this state prohibiting a health carrier from practicing medicine 
 13.4   or being licensed to practice medicine may be asserted as a 
 13.5   defense by the health carrier in an action brought against it 
 13.6   pursuant to this section or any other law. 
 13.7      Subd. 6.  [NONAPPLICATION.] This chapter does not apply to 
 13.8   workers' compensation insurance coverage under chapter 79 or 
 13.9   workers' compensation self-insurance under chapter 79A. 
 13.10     Subd. 7.  [RECOVERY OF ATTORNEY FEES AND OTHER 
 13.11  EXPENSES.] If an enrollee is the prevailing party in a 
 13.12  proceeding under this section, the court shall award attorney 
 13.13  fees and other reasonable expenses to the enrollee.  This 
 13.14  subdivision does not preclude an enrollee from recovering costs, 
 13.15  disbursements, fees, and expenses under other applicable law. 
 13.16     Sec. 18.  Minnesota Statutes 1998, section 144.335, is 
 13.17  amended by adding a subdivision to read: 
 13.18     Subd. 2a.  [DISCLOSURE OF INCENTIVE AGREEMENTS.] A provider 
 13.19  shall disclose to a patient in writing the precise reimbursement 
 13.20  methodology used by the patient's health plan company as defined 
 13.21  under section 62J.70 to reimburse the provider.  The disclosure 
 13.22  must explain clearly and in plain, ordinary language any aspects 
 13.23  of the reimbursement methodology that creates a direct or 
 13.24  indirect financial incentive for the provider to limit or 
 13.25  restrict the health care provided to that patient.  The 
 13.26  disclosure must be made at each appointment. 
 13.27     Sec. 19.  Minnesota Statutes 1998, section 147.081, 
 13.28  subdivision 3, is amended to read: 
 13.29     Subd. 3.  [PRACTICE OF MEDICINE DEFINED.] For purposes of 
 13.30  this chapter, a person not exempted under section 147.09 is 
 13.31  "practicing medicine" or engaged in the "practice of medicine" 
 13.32  if the person does any of the following:  
 13.33     (1) advertises, holds out to the public, or represents in 
 13.34  any manner that the person is authorized to practice medicine in 
 13.35  this state; 
 13.36     (2) offers or undertakes to prescribe, give, or administer 
 14.1   any drug or medicine for the use of another; 
 14.2      (3) offers or undertakes to prevent or to diagnose, 
 14.3   correct, or treat in any manner or by any means, methods, 
 14.4   devices, or instrumentalities, any disease, illness, pain, 
 14.5   wound, fracture, infirmity, deformity or defect of any person; 
 14.6      (4) offers or undertakes to perform any surgical operation 
 14.7   including any invasive or noninvasive procedures involving the 
 14.8   use of a laser or laser assisted device, upon any person; 
 14.9      (5) offers to undertake to use hypnosis for the treatment 
 14.10  or relief of any wound, fracture, or bodily injury, infirmity, 
 14.11  or disease; or 
 14.12     (6) uses in the conduct of any occupation or profession 
 14.13  pertaining to the diagnosis of human disease or conditions, the 
 14.14  designation "doctor of medicine," "medical doctor," "doctor of 
 14.15  osteopathy," "osteopath," "osteopathic physician," "physician," 
 14.16  "surgeon," "M.D.," "D.O.," or any combination of these 
 14.17  designations; or 
 14.18     (7) makes a determination not to certify an admission, 
 14.19  service, procedure, or extension of a hospital stay under 
 14.20  chapter 62M.