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HF 3694

as introduced - 90th Legislature (2017 - 2018) Posted on 03/21/2018 02:12pm

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

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Bill Text Versions

Engrossments
Introduction Pdf Posted on 03/12/2018

Current Version - as introduced

A bill for an act
relating to health insurance; requiring health carriers to offer one health plan that
is an any willing provider option; proposing coding for new law in Minnesota
Statutes, chapter 62K.

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

Section 1.

[62K.16] ANY WILLING PROVIDER HEALTH PLAN OPTION
PROTECTING CHOICE FOR PATIENTS.

(a) A health carrier must offer at least one health plan in individual and small group
markets if the health carrier offers products in that market that maintain a provider network
that is open to all licensed health care providers in the state who agree to accept the terms
and conditions that are offered by the health carrier, so long as the same terms and conditions
are offered to all network providers.

(b) The health carrier may require the provider to meet reasonable referral, utilization
review, and quality assurance requirements on the same basis as other network providers.

(c) The provider and health carrier may negotiate the payment for covered services
provided by the provider. The rates must be at least 120 percent of the rates defined by the
most recent Medicare Physician Fee Schedule Scale as promulgated by the Centers for
Medicare and Medicaid Services, and for primary care providers who are certified as health
care homes under section 256B.0751, the rates must be at least 140 percent.

(d) The health carrier shall not impose a co-payment, fee, or other cost-sharing
requirement for selecting or designating a network provider or impose other conditions that
may limit an enrollee's ability to utilize any provider with the health carrier's provider
network. The health carrier may impose cost-sharing requirements, fees, conditions, or
limits upon an enrollee's selection or designation if the requirements, fees, conditions, or
limits apply to all the providers within the health plan's network.

(e) Nothing in this section requires a provider to contract with a health carrier or accept
a specific payment rate for services provided.

(f) Nothing in this section shall be construed to require a health carrier to provide coverage
for a health care service or treatment that is not covered under the enrollee's health plan.

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