SF 960

1st Engrossment - 80th Legislature (1997 - 1998) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health care; prohibiting contracts that 
  1.3             restrict communication between providers and their 
  1.4             patients; requiring disclosure of health care provider 
  1.5             financial incentives; requiring health plan companies 
  1.6             to provide continuity of care and access to specialty 
  1.7             care for certain enrollees; prohibiting certain 
  1.8             exclusive arrangements; amending Minnesota Statutes 
  1.9             1996, sections 181.932, subdivision 1; and 214.16, 
  1.10            subdivisions 1 and 3; proposing coding for new law in 
  1.11            Minnesota Statutes, chapters 62J; 62Q; and 144. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13     Section 1.  [LEGISLATIVE INTENT.] 
  1.14     It is the intent of the legislature in the Patient 
  1.15  Protection Act to establish additional state consumer 
  1.16  protections and assistance relating to the coverage for and 
  1.17  delivery of health care treatment and services that will 
  1.18  supplement and complement existing laws and regulations and 
  1.19  further ensure that no patient receiving services or treatment 
  1.20  within Minnesota will be harmed by inappropriate health care 
  1.21  practices or treatment, and to provide improved assistance to 
  1.22  consumers and patients who have questions or problems relating 
  1.23  to their health care coverage or treatment. 
  1.24     Sec. 2.  [62J.695] [CITATION.] 
  1.25     Sections 62J.70 to 62J.75 may be cited as the "Patient 
  1.26  Protection Act." 
  1.27     Sec. 3.  [62J.70] [DEFINITIONS.] 
  1.28     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
  2.1   62J.70 to 62J.75, the terms defined in this section have the 
  2.2   meanings given them. 
  2.3      Subd. 2.  [HEALTH CARE PROVIDER OR PROVIDER.] "Health care 
  2.4   provider" or "provider" means: 
  2.5      (1) a physician, nurse, or other provider as defined under 
  2.6   section 62J.03; 
  2.7      (2) a hospital as defined under section 144.696, 
  2.8   subdivision 3; 
  2.9      (3) an individual or entity that provides health care 
  2.10  services under the medical assistance, general assistance 
  2.11  medical care, MinnesotaCare, or state employee group insurance 
  2.12  program; and 
  2.13     (4) an association, partnership, corporation, limited 
  2.14  liability corporation, or other organization of persons or 
  2.15  entities described in clause (1) or (2) organized for the 
  2.16  purposes of providing, arranging, or administering health care 
  2.17  services or treatment.  
  2.18     This section does not apply to trade associations, 
  2.19  membership associations of health care professionals, or other 
  2.20  organizations that do not directly provide, arrange, or 
  2.21  administer health care services or treatment. 
  2.22     Subd. 3.  [HEALTH PLAN COMPANY.] "Health plan company" 
  2.23  means health plan company as defined in section 62Q.01, 
  2.24  subdivision 4. 
  2.25     Subd. 4.  [ENROLLEE.] "Enrollee" means an individual 
  2.26  covered by a health plan company or health insurance or health 
  2.27  coverage plan and includes an insured policyholder, subscriber, 
  2.28  contract holder, member, covered person, or certificate holder.  
  2.29     Sec. 4.  [62J.71] [PROHIBITED PROVIDER CONTRACTS.] 
  2.30     Subdivision 1.  [AGREEMENTS PROHIBITED.] The following 
  2.31  types of agreements are contrary to state public policy, are 
  2.32  prohibited under this section, and are null and void: 
  2.33     (1) any agreement that prohibits a health care provider 
  2.34  from communicating with a patient with respect to the patient's 
  2.35  health status, health care, or treatment options, if the health 
  2.36  care provider is acting in good faith and within the provider's 
  3.1   scope of practice as defined by law; 
  3.2      (2) any agreement that prohibits a health care provider 
  3.3   from disclosing accurate information about whether services or 
  3.4   treatment will be paid for by a patient's health plan company or 
  3.5   health insurance or health coverage plan; and 
  3.6      (3) any agreement that prohibits a health care provider 
  3.7   from informing a patient about the nature of the reimbursement 
  3.8   methodology used by a patient's health insurance or health 
  3.9   coverage plan to pay the provider. 
  3.10     Subd. 2.  [PERSONS AND ENTITIES AFFECTED.] The following 
  3.11  persons and entities shall not enter into any agreement that is 
  3.12  prohibited under this section: 
  3.13     (1) a health plan company; 
  3.14     (2) a health care network cooperative as defined under 
  3.15  section 62R.04, subdivision 3; or 
  3.16     (3) a health care provider as defined in section 62J.70, 
  3.17  subdivision 2. 
  3.18     Subd. 3.  [RETALIATION PROHIBITED.] No person, health plan 
  3.19  company, or other organization may take retaliatory action 
  3.20  against a health care provider solely on the grounds that the 
  3.21  provider: 
  3.22     (1) refused to enter into an agreement or provide services 
  3.23  or information in a manner that is prohibited under this 
  3.24  section; 
  3.25     (2) disclosed accurate information about whether a health 
  3.26  care service or treatment is covered by a patient's health 
  3.27  insurance or health coverage plan; or 
  3.28     (3) expressed personal disagreement with a decision made by 
  3.29  a person, organization, or health care provider regarding 
  3.30  treatment or coverage provided to a patient of the provider, or 
  3.31  assisted the patient in seeking reconsideration of such a 
  3.32  decision, provided the health care provider makes it clear that 
  3.33  the provider is acting in a personal capacity and not as a 
  3.34  representative of or on behalf of the entity that made the 
  3.35  decision.  
  3.36     Subd. 4.  [EXCLUSION.] (a) Nothing in this section prevents 
  4.1   any person or organization from taking actions, which may 
  4.2   adversely affect a provider whose actions the person or 
  4.3   organization reasonably believes to be illegal, to constitute 
  4.4   medical malpractice, or to be contrary to accepted medical 
  4.5   practices. 
  4.6      (b) Nothing in this section prohibits a contract provision 
  4.7   that requires any contracting party to keep confidential or to 
  4.8   not use or disclose the specific amounts paid to a provider, 
  4.9   provider fee schedules, provider salaries, and other proprietary 
  4.10  information of a specific health plan.  
  4.11     Sec. 5.  [62J.72] [DISCLOSURE OF HEALTH CARE PROVIDER 
  4.12  INFORMATION.] 
  4.13     Subdivision 1.  [WRITTEN DISCLOSURE.] A health plan 
  4.14  company, as defined under section 62J.70, subdivision 4, a 
  4.15  health care network cooperative as defined under section 62R.04, 
  4.16  subdivision 3, and a health care provider as defined under 
  4.17  section 62J.70, subdivision 2, shall, upon enrollment and 
  4.18  annually thereafter, provide enrollees with a description of the 
  4.19  general nature of the reimbursement methodologies used by the 
  4.20  health insurance or health coverage plan to pay providers.  This 
  4.21  description may be incorporated into the member handbook, 
  4.22  subscriber contract, or certificate.  Upon request, a health 
  4.23  plan company or provider must provide an enrollee or patient 
  4.24  with specific information regarding the reimbursement 
  4.25  methodology, including, but not limited to, the following 
  4.26  information:  
  4.27     (1) a concise written description of any provider payment 
  4.28  plan, including any incentive plan applicable to the enrollee; 
  4.29     (2) a written description of any incentive to the provider 
  4.30  relating to the provision of health care services to patients, 
  4.31  including any compensation arrangement that is dependent on the 
  4.32  amount of health coverage or health care services provided to a 
  4.33  patient, or the number of referrals to or utilization of 
  4.34  specialists; and 
  4.35     (3) a written description of any incentive plan that 
  4.36  involves the transfer of financial risk to a health care 
  5.1   provider. 
  5.2   This subdivision does not require disclosure of specific amounts 
  5.3   paid to a provider, provider fee schedules, provider salaries, 
  5.4   or other proprietary information of a specific health plan 
  5.5   company or health insurance or health coverage plan or provider. 
  5.6      Subd. 2.  [INFORMATION ON PATIENTS' MEDICAL BILLS.] A 
  5.7   health plan company and health care provider shall provide 
  5.8   patients and enrollees with a copy of an itemized and 
  5.9   intelligible bill whenever the patient or enrollee is sent a 
  5.10  bill and is responsible for paying any portion of that bill.  
  5.11  The bills must contain descriptive language sufficient to be 
  5.12  understood by the average patient or enrollee.  This subdivision 
  5.13  does not apply to a flat co-pay paid by the patient at the time 
  5.14  the service is required.  
  5.15     Subd. 3.  [NONAPPLICABILITY.] Health care providers as 
  5.16  defined in section 62J.70, subdivision 2, clause (1), need not 
  5.17  individually provide information required under this section if 
  5.18  it has been provided by another entity that is subject to this 
  5.19  section. 
  5.20     Sec. 6.  [62J.73] [PROHIBITION ON EXCLUSIVE ARRANGEMENTS.] 
  5.21     Subdivision 1.  [EXCLUSIVE ARRANGEMENT.] For purposes of 
  5.22  this section, "exclusive arrangement" means any agreement or 
  5.23  contract, including but not limited to, acquisition, purchase, 
  5.24  affiliation, or consulting agreements with a health plan company 
  5.25  or health care provider, which has the purpose or effect of:  
  5.26     (1) committing any person providing health care services to 
  5.27  accept and treat as patients the enrollees of a health plan 
  5.28  company to the exclusion of enrollees who have coverage through 
  5.29  any other health plan company; 
  5.30     (2) providing reimbursement on sliding scales, capitation 
  5.31  rates, payment schedules, or other payment arrangements as a 
  5.32  financial incentive for persons providing health care services 
  5.33  to restrict treatment to enrollees who have coverage through any 
  5.34  other health plan company; 
  5.35     (3) providing reimbursement on sliding scales, capitation 
  5.36  rates, payment schedules, or other payment arrangements that 
  6.1   contain a financial penalty for failing to restrict treatment to 
  6.2   enrollees who have coverage through any other health plan 
  6.3   company; 
  6.4      (4) restricting any person's right to provide health 
  6.5   services, goods, or procedures to another provider or health 
  6.6   plan company; or 
  6.7      (5) preventing any person providing goods or health care 
  6.8   services from contracting with any health plan company or 
  6.9   provider. 
  6.10     Subd. 2.  [PROHIBITION ON EXCLUSIVE ARRANGEMENTS.] No 
  6.11  provider or health plan company shall enter into any new 
  6.12  exclusive arrangement or renew an existing exclusive arrangement 
  6.13  with any person, unless the person is an employee.  No provider 
  6.14  or health plan company shall maintain any existing exclusive 
  6.15  arrangement with any person, unless that person is an employee.  
  6.16     Subd. 3.  [ANTITRUST VIOLATIONS.] The attorney general's 
  6.17  office shall investigate, as a possible violation of the 
  6.18  Minnesota antitrust law, any arrangement in which a provider 
  6.19  enters into or maintains an arrangement with a health plan 
  6.20  company, which has the effect of limiting the provider to 
  6.21  providing health care services to the enrollees of a health plan 
  6.22  company to the exclusion of enrollees who have coverage through 
  6.23  any other health plan company. 
  6.24     Sec. 7.  [62J.74] [ENFORCEMENT.] 
  6.25     Subdivision 1.  [AUTHORITY.] The commissioners of health 
  6.26  and commerce shall each periodically review contracts and 
  6.27  arrangements among health care providing entities and health 
  6.28  plan companies they regulate to determine compliance with 
  6.29  sections 62J.70 to 62J.73.  Any person may submit a contract or 
  6.30  arrangement to the relevant commissioner for review if the 
  6.31  person believes sections 62J.70 to 62J.73 have been violated.  
  6.32  Any provision of a contract or arrangement found by the relevant 
  6.33  commissioner to violate this section is null and void, and the 
  6.34  relevant commissioner may assess civil penalties against the 
  6.35  health plan company in an amount not to exceed $2,500 for each 
  6.36  day the contract or arrangement is in effect, and may use the 
  7.1   enforcement procedures otherwise available to the commissioner. 
  7.2      Subd. 2.  [ASSISTANCE TO LICENSING BOARDS.] A 
  7.3   health-related licensing board as defined under section 214.01, 
  7.4   subdivision 2, shall submit a contract or arrangement to the 
  7.5   relevant commissioner for review if the board believes sections 
  7.6   62J.70 to 62J.73 have been violated.  If the commissioner 
  7.7   determines that any provision of a contract or arrangement 
  7.8   violates those sections, the board shall take disciplinary 
  7.9   action against any person who is licensed or regulated by the 
  7.10  board who entered into the contract arrangement. 
  7.11     Sec. 8.  [62J.75] [NONPREEMPTION.] 
  7.12     Nothing in the Patient Protection Act preempts or replaces 
  7.13  requirements related to patient protections that are more 
  7.14  protective of patient rights than the requirements established 
  7.15  by the Patient Protection Act. 
  7.16     Sec. 9.  [62Q.56] [CONTINUITY OF CARE.] 
  7.17     Subdivision 1.  [CHANGE IN HEALTH CARE PROVIDER.] (a) A 
  7.18  health plan company and a health care network cooperative, as 
  7.19  defined under section 62R.04, subdivision 3, shall prepare a 
  7.20  written plan that provides for continuity of care in the event 
  7.21  of contract termination between the health plan company or 
  7.22  health care network cooperative and any of its contracted 
  7.23  primary care providers or general hospital providers.  The 
  7.24  written plan must explain: 
  7.25     (1) how the health plan company or health care network 
  7.26  cooperative will inform affected enrollees, insureds, or 
  7.27  beneficiaries about termination at least 30 days before the 
  7.28  termination is effective, if the health plan company or health 
  7.29  care network cooperative has received at least 120 days' prior 
  7.30  notice; 
  7.31     (2) how the health plan company or health care network 
  7.32  cooperative will inform the affected enrollees about what other 
  7.33  participating providers are available to assume care and how it 
  7.34  will facilitate an orderly transfer of its enrollees, insureds, 
  7.35  or beneficiaries from the terminating provider to the new 
  7.36  provider to maintain continuity of care; 
  8.1      (3) the procedures by which enrollees, insureds, or 
  8.2   beneficiaries will be transferred to other participating 
  8.3   providers, when special medical needs, special risks, or other 
  8.4   special circumstances, such as cultural or language barriers, 
  8.5   require them to have a longer transition period or be 
  8.6   transferred to nonparticipating providers; 
  8.7      (4) who will identify enrollees, insureds, or beneficiaries 
  8.8   with special medical needs or at special risk and what criteria 
  8.9   will be used for this determination; and 
  8.10     (5) how continuity of care will be provided for enrollees, 
  8.11  insureds, or beneficiaries identified as having special needs or 
  8.12  at special risk, and whether the health plan company or health 
  8.13  care network cooperative has assigned this responsibility to its 
  8.14  contracted primary care providers. 
  8.15     (b) If the contract termination was not for cause, 
  8.16  enrollees can request a referral to the terminating provider for 
  8.17  up to 120 days if they have special medical needs or have other 
  8.18  special circumstances, such as cultural or language barriers.  
  8.19  The health plan company or health care network cooperative can 
  8.20  require medical records and other supporting documentation in 
  8.21  support of the requested referral.  Each request for referral to 
  8.22  a terminating provider shall be considered by the health plan 
  8.23  company or health care network cooperative on a case-by-case 
  8.24  basis. 
  8.25     (c) If the contract termination was for cause, enrollees 
  8.26  must be notified of the change and transferred to participating 
  8.27  providers in a timely manner so that health care services remain 
  8.28  available and accessible to the affected enrollees.  The health 
  8.29  plan company or health care network cooperative is not required 
  8.30  to refer an enrollee, insured, or beneficiary back to the 
  8.31  terminating provider if the termination was for cause. 
  8.32     Subd. 2.  [CHANGE IN HEALTH PLANS.] (a) The health plan 
  8.33  company or health care network cooperative shall prepare a 
  8.34  written plan that provides a process for coverage determinations 
  8.35  for continuity of care for new enrollees with special needs, 
  8.36  special risks, or other special circumstances, such as cultural 
  9.1   or language barriers, who request continuity of care with their 
  9.2   former provider for up to 120 days.  The written plan must 
  9.3   explain the criteria that will be used for determining special 
  9.4   needs cases, and how continuity of care will be provided. 
  9.5      (b) This subdivision applies only to group coverage and 
  9.6   continuation and conversion coverage. 
  9.7      Subd. 3.  [DISCLOSURES.] The written plans required under 
  9.8   this section must be made available upon request to enrollees or 
  9.9   prospective enrollees. 
  9.10     Sec. 10.  [62Q.58] [ACCESS TO SPECIALTY CARE.] 
  9.11     Subdivision 1.  [STANDING REFERRAL.] A health plan company 
  9.12  shall establish a procedure by which an enrollee may apply for a 
  9.13  standing referral to a health care provider who is a 
  9.14  specialist.  This procedure for a standing referral must specify 
  9.15  the necessary criteria and conditions, which must be met in 
  9.16  order for an enrollee to obtain a standing referral. 
  9.17     Subd. 2.  [COORDINATION OF SERVICES.] A primary care 
  9.18  provider or primary care group shall remain responsible for 
  9.19  coordinating the care of an enrollee who has received a standing 
  9.20  referral to a specialist.  The specialist shall not make any 
  9.21  secondary referrals related to primary care services without 
  9.22  prior approval by the primary care provider or primary care 
  9.23  group.  However, an enrollee with a standing referral to a 
  9.24  specialist may request primary care services from that 
  9.25  specialist.  The specialist, in agreement with the enrollee and 
  9.26  primary care provider or primary care group, may elect to 
  9.27  provide primary care services to that enrollee according to 
  9.28  procedures established by the health plan company.  
  9.29     Subd. 3.  [DISCLOSURE.] Information regarding standing 
  9.30  referral procedures for requesting primary care services from a 
  9.31  specialist must be included in member contracts or certificates 
  9.32  of coverage and must be provided to an enrollee or prospective 
  9.33  enrollee by a health plan company upon request. 
  9.34     Sec. 11.  [144.6585] [IDENTIFICATION OF HEALTH CARE 
  9.35  PROVIDERS.] 
  9.36     Any health care provider who is licensed, credentialed, or 
 10.1   registered by a health-related licensing board as defined under 
 10.2   section 214.01, subdivision 2, must wear a name tag that 
 10.3   indicates by words, letters, abbreviations, or insignia the 
 10.4   profession or occupation of the individual.  The name tag must 
 10.5   be worn whenever the health care provider is rendering health 
 10.6   services to a patient, unless wearing the name tag would create 
 10.7   a safety or health risk to the patient.  
 10.8      Sec. 12.  Minnesota Statutes 1996, section 181.932, 
 10.9   subdivision 1, is amended to read: 
 10.10     Subdivision 1.  [PROHIBITED ACTION.] An employer shall not 
 10.11  discharge, discipline, threaten, otherwise discriminate against, 
 10.12  or penalize an employee regarding the employee's compensation, 
 10.13  terms, conditions, location, or privileges of employment because:
 10.14     (a) the employee, or a person acting on behalf of an 
 10.15  employee, in good faith, reports a violation or suspected 
 10.16  violation of any federal or state law or rule adopted pursuant 
 10.17  to law to an employer or to any governmental body or law 
 10.18  enforcement official; 
 10.19     (b) the employee is requested by a public body or office to 
 10.20  participate in an investigation, hearing, inquiry; or 
 10.21     (c) the employee refuses an employer's order to perform an 
 10.22  action that the employee has an objective basis in fact to 
 10.23  believe violates any state or federal law or rule or regulation 
 10.24  adopted pursuant to law, and the employee informs the employer 
 10.25  that the order is being refused for that reason; or 
 10.26     (d) the employee, in good faith, reports a situation in 
 10.27  which the quality of the health care services provided by a 
 10.28  health care facility, organization, or health care provider 
 10.29  places the public at risk of harm.  
 10.30     Sec. 13.  Minnesota Statutes 1996, section 214.16, 
 10.31  subdivision 1, is amended to read: 
 10.32     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 10.33  section, the following terms have the meanings given them. 
 10.34     (a) "Board" means the boards of medical practice, 
 10.35  chiropractic examiners, nursing, optometry, dentistry, pharmacy, 
 10.36  psychology, social work, marriage and family therapy, and 
 11.1   podiatry. 
 11.2      (b) "Regulated person" means a licensed physician, 
 11.3   chiropractor, nurse, optometrist, dentist, pharmacist, or 
 11.4   podiatrist. 
 11.5      Sec. 14.  Minnesota Statutes 1996, section 214.16, 
 11.6   subdivision 3, is amended to read: 
 11.7      Subd. 3.  [GROUNDS FOR DISCIPLINARY ACTION.] The board 
 11.8   shall take disciplinary action, which may include license 
 11.9   revocation, against a regulated person for: 
 11.10     (1) intentional failure to provide the commissioner of 
 11.11  health with the data required under chapter 62J; 
 11.12     (2) intentional failure to provide the commissioner of 
 11.13  revenue with data on gross revenue and other information 
 11.14  required for the commissioner to implement sections 295.50 to 
 11.15  295.58; and 
 11.16     (3) intentional failure to pay the health care provider tax 
 11.17  required under section 295.52; and 
 11.18     (4) entering into a contract or arrangement that is 
 11.19  prohibited under sections 62J.70 to 62J.73. 
 11.20     Sec. 15.  [CONSOLIDATION AND COORDINATION OF CONSUMER 
 11.21  ASSISTANCE AND ADVOCACY OFFICES.] 
 11.22     The commissioners of health and commerce, in consultation 
 11.23  with the commissioners of human services and employee relations, 
 11.24  shall study the feasibility and desirability of consolidating 
 11.25  and improving coordination of some or all existing state 
 11.26  consumer assistance, ombudsperson, and advocacy activities.  The 
 11.27  commissioners shall submit a report with recommendations, and 
 11.28  draft legislation to the legislature by January 15, 1998.