SF 389

as introduced - 87th Legislature (2011 - 2012) Posted on 02/23/2012 08:46am

A bill for an act
relating to insurance; no-fault auto; regulating uninsured and underinsured
coverages, medical benefits, arbitration, and marketing practices; reducing
automobile medical fraud; amending Minnesota Statutes 2010, sections 65B.44,
subdivisions 1, 2; 65B.525, by adding subdivisions; 65B.54, subdivisions 4, 6,
by adding subdivisions; 609.612, subdivision 1.

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

ARTICLE 1

NO-FAULT MEDICAL
BENEFIT/ARBITRATION REFORMS

Section 1.

Minnesota Statutes 2010, section 65B.44, subdivision 1, is amended to read:

Subdivision 1.

Inclusions.

(a) Basic economic loss benefits shall provide
reimbursement for all loss suffered through injury arising out of the maintenance or use
of a motor vehicle, subject to any applicable deductibles, exclusions, disqualifications,
and other conditions, and shall provide a minimum of $40,000 for loss arising out of the
injury of any one person, consisting of:

(1) $20,000 for medical expense loss arising out of injury to any one person; and

(2) a total of $20,000 for income loss, replacement services loss, funeral expense
loss, survivor's economic loss, and survivor's replacement services loss arising out of the
injury to any one person.

(b) Notwithstanding any other law to the contrary, a person entitled to basic
economic loss benefits under this chapter is entitled to the full medical expense benefits set
forth in subdivision 2, and may not receive medical expense benefits that are in any way
less than those provided for in subdivision 2, or that involve any preestablished limitations
on the benefits. Medical expenses must be reasonable and must be for necessary medical
care as provided in subdivision 2. This paragraph shall not be deemed to alter the
obligations of an insured or the rights of a reparation obligor as set forth in section 65B.56. new text begin
This paragraph does not apply to medical expense loss that is subject to paragraph (d).
new text end

(c) No reparation obligor or health plan company as defined in section 62Q.01,
subdivision 4, may enter into or renew any contract that provides, or has the effect of
providing, managed care services to no-fault claimants. For the purposes of this section,
"managed care services" is defined as any program of medical services that uses health care
providers managed, owned, employed by, or under contract with a health plan company.

new text begin (d) Medical expense loss for diagnosis and treatment of a soft tissue injury is
covered only if provided in compliance with the codes, treatment standards, and fee
schedules provided in Minnesota Rules, chapter 5221. For purposes of this section, "soft
tissue injury" means an injury to the soft tissues, as opposed to the skeletal tissues or
soft organs. The term soft tissue injury specifically includes, without limitation, any
injury with treatment covered by the procedure codes set forth in Minnesota Rules,
part 5221.4060, other than such treatment delivered by a health care provider defined
in Minnesota Rules, part 5221.0100, subpart 11a, or by a medical facility described in
section 176.136, subdivision 1b, paragraphs (a) and (b).
new text end

Sec. 2.

Minnesota Statutes 2010, section 65B.44, subdivision 2, is amended to read:

Subd. 2.

Medical expense benefits.

(a) Medical expense benefits shall reimburse
all deleted text begin reasonable deleted text end new text begin usual and customary new text end expenses new text begin incurred within seven days from the date
of loss new text end for new text begin medically new text end necessary:

(1) medical, surgical, x-ray, optical, dental, chiropractic, and rehabilitative services,
including prosthetic devices;

(2) prescription drugs;

(3) ambulance and all other transportation expenses incurred in traveling to receive
other covered medical expense benefits;

(4) sign interpreting and language translation services, other than such services
provided by a family member of the patient, related to the receipt of medical, surgical,
x-ray, optical, dental, chiropractic, hospital, extended care, nursing, and rehabilitative
services; and

(5) hospital, extended care, and nursing services.

(b) Hospital room and board benefits may be limited, except for intensive care
facilities, to the regular daily semiprivate room rates customarily charged by the institution
in which the recipient of benefits is confined.

(c) Such benefits shall also include necessary remedial treatment and services
recognized and permitted under the laws of this state for an injured person who relies
upon spiritual means through prayer alone for healing in accordance with that person's
religious beliefs.

(d) Medical expense loss includes medical expenses accrued prior to the death of a
person notwithstanding the fact that benefits are paid or payable to the decedent's survivors.

(e) Medical expense benefits for rehabilitative services shall be subject to the
provisions of section 65B.45.

Sec. 3.

Minnesota Statutes 2010, section 65B.525, is amended by adding a subdivision
to read:

new text begin Subd. 3. new text end

new text begin Itemization; right to participate; full payment. new text end

new text begin All arbitration awards
must be itemized. A partial award of medical benefits rendered by an arbitrator under this
section and paid by an obligor will be considered full and final payment, and the injured
party is not liable for, nor may the provider bill the injured party for, charges that are not
part of the award, pursuant to section 65B.54, subdivision 8. A health care provider's
participation as a party in an arbitration proceeding is limited to any issues related to the
treatment or charges arising out of the claim that is the subject of the arbitration. This
subdivision does not apply to charges for health care that are not related to the accident.
new text end

Sec. 4.

Minnesota Statutes 2010, section 65B.525, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Notice to providers. new text end

new text begin The itemization of medical services claims required
pursuant to subdivision 3 must include the names and addresses of all health care providers
whose charges are the subject of the claims. Within ten business days after receipt of the
itemization, the administrator of arbitration under this section must send a copy of the
petition and itemization to each health care provider whose charges are the subject of
claims, together with a notice of the content of subdivision 3 and of the provider's right to
participate as a party to the proceeding. The notice must explain to the provider what steps
the provider must take in order to participate.
new text end

Sec. 5.

Minnesota Statutes 2010, section 65B.54, is amended by adding a subdivision
to read:

new text begin Subd. 7. new text end

new text begin Balance billing. new text end

new text begin (a) This subdivision applies to charges for medical
expense benefits as defined in section 65B.44, subdivision 2, to the extent that a reparation
obligor has rejected them on the basis that the health care was not medically necessary or
on the basis that the charges exceed the usual and customary rate.
new text end

new text begin (b) If a reparation obligor rejects, in whole or in part, a claim for health care
provided to the claimant by a health care provider, for reasons specified in paragraph (a),
the claimant is not obligated to pay the health care provider for the rejected charges.
new text end

new text begin (c) The health care provider shall not bill the claimant for those charges or otherwise
attempt to collect them from the claimant after they have been rejected by the insurer.
new text end

new text begin (d) A health care provider whose charges are rejected, in whole or in part, under this
section by a reparation obligor, is the party at interest and has standing to commence and
pursue a claim for payment as a claimant against the reparation obligor in an arbitration
proceeding under section 65B.525. In such a proceeding, the insured may be required
to attend the arbitration proceeding by either the reparation obligor or the health care
provider, subject to the conditions provided in section 65B.56, subdivision 2.
new text end

new text begin (e) A health care provider shall not require an insured to waive any provision of this
section, and any such attempted waiver is void and unenforceable.
new text end

ARTICLE 2

AGGRESSIVE HEALTH CARE PROVIDER
MARKETING PRACTICES REFORMS

Section 1.

Minnesota Statutes 2010, section 65B.54, subdivision 4, is amended to read:

Subd. 4.

Recovery of benefits paid due to intentional misrepresentation.

A
reparation obligor may bring an action to recover benefits which are not payable, but are
in fact paid, because of an intentional misrepresentation of a material fact, upon which the
reparation obligor relies, by the claimant or by a person providing products or services
for which basic economic loss benefits are payable. The action may be brought only
against the person providing the products or services, unless the claimant has intentionally
misrepresented the facts or knew of the misrepresentation. new text begin A reparation obligor may
recover damages under this subdivision by showing that the person or clinic providing the
products or services engaged in a pattern and practice of intentional misrepresentation of
material fact or fraud. new text end A reparation obligor may offset amounts the reparation obligor is
entitled to recover from the claimant under this subdivision against any basic economic
loss benefits otherwise due the claimant.

Sec. 2.

Minnesota Statutes 2010, section 65B.54, subdivision 6, is amended to read:

Subd. 6.

Unethical practices.

(a) A licensed health care provider shall not initiate
direct contact, in person, over the telephone, or by other electronic means, with any person
who has suffered an injury arising out of the maintenance or use of an automobile, for the
purpose of influencing that person to receive treatment or to purchase any good or item
from the licensee or anyone associated with the licensee. This subdivision prohibits such
direct contact whether initiated by the licensee individually or on behalf of the licensee by
any employee, independent contractor, agent, or third party new text begin , including, without limitation,
a capper, runner, or steerer, as defined in section 609.612, subdivision 1, paragraph (c) new text end .
This subdivision does not apply when an injured person voluntarily initiates contact with a
licensee.

(b) This subdivision does not prohibit licensees deleted text begin , or persons acting on their behalf, deleted text end
from mailing advertising literature directly to such persons, so long as:

(1) the word "ADVERTISEMENT" appears clearly and conspicuously at the
beginning of the written materials;

(2) the name of the individual licensee appears clearly and conspicuously within
the written materials;

(3) the licensee is clearly identified as a licensed health care provider within the
written materials; and

(4) the licensee does not initiate, individually or through any employee, independent
contractor, agent, or third party, direct contact with the person after the written materials
are sent.

(c) new text begin If undertaken directly by the health care provider only in its own legal name,
new text end this subdivision does not apply to:

(1) advertising that does not involve direct contact with specific prospective patients,
in public media such as telephone directories, professional directories, ads in newspapers
and other periodicals, radio or television ads, Web sites, billboards, or similar media;

(2) general marketing practices such as giving lectures; participating in special
events, trade shows, or meetings of organizations; or making presentations relative to the
benefits of chiropractic treatment;

(3) contact with friends or relatives, or statements made in a social setting;

(4) direct contact initiated by an ambulance service licensed under chapter 144E, a
medical response unit registered under section 144E.275, or by the emergency department
of a hospital licensed under chapter 144, for the purpose of rendering emergency care; or

(5) a situation in which the injured person:

(i) had a prior professional relationship with the licensee;

(ii) has selected that licensee as the licensee from whom the injured person receives
health care; or

(iii) has received treatment related to the accident from the licensee.

(d) A violation of this subdivision is grounds for the licensing authority to take
disciplinary action against the licensee new text begin , its professional corporation, or any direct or
indirect successor in interest of the corporation new text end , including revocation in appropriate cases. new text begin
In addition, charges for any services provided by a health care provider in violation of this
subdivision are not compensable and not enforceable as a matter of law.
new text end

Sec. 3.

Minnesota Statutes 2010, section 65B.54, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Media-generated referrals. new text end

new text begin (a) No health care provider shall pay, offer, or
provide any compensation, fee, or anything of value to an individual, firm, corporation,
or other legal entity for referring a person identified by use of the public media, such as
telephone directories, professional directories, advertisements in newspapers and other
periodicals, radio or television advertisements, Web sites, billboards, or similar media,
for purposes of influencing or referring that person to receive treatment or purchase any
good or item from the health care provider or anyone associated with the health care
provider for any injury arising out of the maintenance or use of an automobile. Charges
for any services provided by a health care provider in violation of this subdivision are not
compensable and not enforceable as a matter of law. The prohibition in this subdivision
does not apply to any advertisement or other contact permitted by subdivision 6. For
purposes of this subdivision, "anything of value" includes agreements or understandings
to refer patients by and between a health care provider, another health care provider, a
lawyer, or any other third party.
new text end

new text begin (b) An affiliate of a health care provider shall not advertise by use of the public media,
such as telephone directories, professional directories, advertisements in newspapers and
other periodicals, radio or television advertisements, Web sites, billboards, or similar
media, as part of a scheme to refer persons injured by use of an automobile to a third party
intending that such persons shall subsequently be referred to the health care provider.
new text end

Sec. 4.

Minnesota Statutes 2010, section 65B.54, is amended by adding a subdivision
to read:

new text begin Subd. 9. new text end

new text begin Inducements. new text end

new text begin No health care provider shall offer, pay, advertise, give, or
provide any gift, prize, bonus, fee, or anything of value whatsoever, directly or indirectly,
that is not a service, item, or good deemed a professional treatment under the standards of
practice for the applicable health care provider, to any person who has suffered an injury
arising out of the maintenance or use of an automobile, for the purpose of inducing or
influencing that person to receive treatment or to purchase any good or item from the
health care provider or anyone associated with the health care provider. Charges for
any services provided by a health care provider in violation of this subdivision are not
compensable and not enforceable as a matter of law.
new text end

Sec. 5.

Minnesota Statutes 2010, section 65B.54, is amended by adding a subdivision
to read:

new text begin Subd. 10. new text end

new text begin Dividing fees. new text end

new text begin It is unlawful for a health care provider to:
new text end

new text begin (1) divide fees received for payment of medical expense benefits under section
65B.44, subdivision 2, with;
new text end

new text begin (2) promise to pay a part of another health care provider's fee to; or
new text end

new text begin (3) pay a commission to,
new text end

new text begin any health care provider or other person who calls the health care provider in consultation
or who sends patients to the health care provider for treatment. Nothing in this subdivision
prevents licensed chiropractors from forming a bona fide partnership for the practice of
chiropractic, nor to the actual employment by a licensed chiropractor of another licensed
chiropractor. Charges for any services provided by a health care provider in violation of
this subdivision are not compensable and not enforceable as a matter of law.
new text end

Sec. 6.

Minnesota Statutes 2010, section 609.612, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

(a) As used in this section, the following terms have
the meanings given.

(b) "Public media" means telephone directories, professional directories, newspapers
and other periodicals, radio and television, billboards, and mailed or electronically
transmitted written communications that do not involve in-person contact with a specific
prospective patient or client.

(c) "Runner," "capper," or "steerer" means a person who deleted text begin for a pecuniary
gain deleted text end procures deleted text begin patients or clients deleted text end new text begin or solicits prospective patients through telephonic
communication, written communication, or in-person contact new text end at the direction of, or in
cooperation with, a health care provider deleted text begin when the person knows or has reason to know
that the provider's purpose is to fraudulently perform or obtain services or benefits under
or relating to a contract of motor vehicle insurance deleted text end . The term new text begin "runner," "capper," or
"steerer" new text end does not include a deleted text begin person deleted text end new text begin licensed health care provider new text end who new text begin directly new text end procures
clients through public media new text begin such as newspaper, radio, or television advertisements only
using its own legal name new text end .

Sec. 7. new text begin TITLE.
new text end

new text begin This act may be cited as the "Reduce Auto Medical Fraud Act."
new text end