SF 1609

as introduced - 90th Legislature (2017 - 2018) Posted on 03/02/2017 09:55am

A bill for an act
relating to health; specifying optometrist services payment and certain contract
requirements; proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

new text begin [62Q.741] OPTOMETRIST SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The terms defined in this subdivision have the meanings
given them.
new text end

new text begin (b) "Materials" means durable medical equipment, prosthetics, orthotics, and supplies
(DMEPOS), including but not limited to lenses, devices containing lenses, artificial
intraocular lenses, ophthalmic frames and other lens mounting apparatus, prisms, lens
treatments and coating contact lenses, and prosthetic devices to correct, relieve, or treat
defects or abnormal conditions of the human eye or its adnexa.
new text end

new text begin (c) "Services" means the health care professional procedures and work performed by an
optometrist as defined in this section, not including the sale of materials.
new text end

new text begin (d) "Vision care plan" means an entity that creates, promotes, sells, provides, advertises,
or administers an integrated or stand-alone vision benefits plan, or a vision care insurance
policy or contract that provides vision benefits to an enrollee through services or materials.
new text end

new text begin Subd. 2. new text end

new text begin Noncovered vision care services contract prohibitions. new text end

new text begin (a) No vision care
plan shall require in any contract with an optometrist that is entered into or amended on or
after January 1, 2018, any provision that:
new text end

new text begin (1) requires the optometrist to accept as payment an amount set by a vision care plan
for a service provided to an insured individual or enrollee that is not a covered service under
the insured individual's or enrollee's plan; and
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new text begin (2) precludes an optometrist from discussing treatment options with a patient.
new text end

new text begin (b) No optometrist shall charge more for services that are not covered services than the
optometrist's usual and customary rate for the services.
new text end

new text begin (c) Each evidence of coverage or provider locator for an individual or a group vision
care plan shall include:
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new text begin (1) the following statement:
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new text begin "IMPORTANT: If a covered member elects to receive vision care services that are not
covered services under this plan, a participating provider may charge the member the
provider's usual and customary rate for the services. Before providing a member with vision
care services that are not covered services, the provider shall provide the member with a
treatment plan that includes each anticipated service or procedure to be provided and the
estimated cost of each service or procedure. To fully understand the coverage, a member
may wish to review the member's complete evidence of coverage document"; and
new text end

new text begin (2) if applicable, a statement that the plan uses a proprietary or exclusive network of
laboratories and suppliers.
new text end

new text begin (d) Each optometrist shall notify patients that services that are not covered services under
an insurance policy or plan might not be offered at a discounted rate by:
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new text begin (1) posting a notice in a conspicuous place;
new text end

new text begin (2) providing the patient with a treatment plan that includes each anticipated service to
be provided and the estimated cost of each service, before providing the patient with services
that are not covered services; and
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new text begin (3) obtaining a written confirmation of understanding from the patient.
new text end

new text begin (e) Optometrists recommending out-of-network suppliers or laboratories must notify
the patient that those suppliers or laboratories are out of network and must further notify
the patient of any ownership or other financial interest or incentive that the optometrist may
have in the use of the out-of-network supplier or laboratory.
new text end