Office of the Revisor of Statutes
Minnesota Session Laws - 1997, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 237-S.F.No. 960
An act relating to health care; providing for patient
protection; requiring certain disclosures; prohibiting
certain provider contracts; providing for continuity
of care and specialty care; prohibiting certain
exclusive arrangements; modifying dispute resolution
provisions; requiring identification of health care
providers; requiring studies; requiring emergency
services coverage; establishing a consumer advisory
board; providing civil penalties; amending Minnesota
Statutes 1996, sections 62Q.105, subdivision 1;
62Q.30; 181.932, subdivision 1; and 214.16,
subdivisions 1 and 3; proposing coding for new law in
Minnesota Statutes, chapters 62J; 62Q; and 144;
repealing Minnesota Statutes 1996, sections 62J.2911;
62J.2912; 62J.2913; 62J.2914; 62J.2915; 62J.2916;
62J.2917; 62J.2918; 62J.2919; 62J.2920; and 62J.2921.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. [62J.695] [CITATION.]
Sections 62J.695 to 62J.76 may be cited as the "Patient
Protection Act."
Sec. 2. [62J.70] [DEFINITIONS.]
Subdivision 1. [APPLICABILITY.] For purposes of sections
62J.70 to 62J.76, the terms defined in this section have the
meanings given them.
Subd. 2. [HEALTH CARE PROVIDER OR PROVIDER.] "Health care
provider" or "provider" means:
(1) a physician, nurse, or other provider as defined under
section 62J.03;
(2) a hospital as defined under section 144.696,
subdivision 3;
(3) an individual or entity that provides health care
services under the medical assistance, general assistance
medical care, MinnesotaCare, or state employee group insurance
program; and
(4) an association, partnership, corporation, limited
liability corporation, or other organization of persons or
entities described in clause (1) or (2) organized for the
purposes of providing, arranging, or administering health care
services or treatment.
This section does not apply to trade associations,
membership associations of health care professionals, or other
organizations that do not directly provide, arrange, or
administer health care services or treatment.
Subd. 3. [HEALTH PLAN COMPANY.] "Health plan company"
means health plan company as defined in section 62Q.01,
subdivision 4.
Subd. 4. [ENROLLEE.] "Enrollee" means an individual
covered by a health plan company or health insurance or health
coverage plan and includes an insured policyholder, subscriber,
contract holder, member, covered person, or certificate holder.
Sec. 3. [62J.71] [PROHIBITED PROVIDER CONTRACTS.]
Subdivision 1. [PROHIBITED AGREEMENTS AND DIRECTIVES.] The
following types of agreements and directives are contrary to
state public policy, are prohibited under this section, and are
null and void:
(1) any agreement that prohibits a health care provider
from communicating with an enrollee with respect to the
enrollee's health status, health care, or treatment options, if
the health care provider is acting in good faith and within the
provider's scope of practice as defined by law;
(2) any agreement or directive that prohibits a health care
provider from making a recommendation regarding the suitability
or desirability of a health plan company, health insurer, or
health coverage plan for an enrollee, unless the provider has a
financial conflict of interest in the enrollee's choice of
health plan company, health insurer, or health coverage plan;
(3) any agreement or directive that prohibits a provider
from providing testimony, supporting or opposing legislation, or
making any other contact with state or federal legislators or
legislative staff or with state and federal executive branch
officers or staff;
(4) any agreement or directive that prohibits a health care
provider from disclosing accurate information about whether
services or treatment will be paid for by a patient's health
plan company or health insurer or health coverage plan; and
(5) any agreement or directive that prohibits a health care
provider from informing an enrollee about the nature of the
reimbursement methodology used by an enrollee's health plan
company, health insurer, or health coverage plan to pay the
provider.
Subd. 2. [PERSONS AND ENTITIES AFFECTED.] The following
persons and entities shall not enter into any agreement or
directive that is prohibited under this section:
(1) a health plan company;
(2) a health care network cooperative as defined under
section 62R.04, subdivision 3; or
(3) a health care provider as defined in section 62J.70,
subdivision 2.
Subd. 3. [RETALIATION PROHIBITED.] No person, health plan
company, or other organization may take retaliatory action
against a health care provider solely on the grounds that the
provider:
(1) refused to enter into an agreement or provide services
or information in a manner that is prohibited under this section
or took any of the actions listed in subdivision 1;
(2) disclosed accurate information about whether a health
care service or treatment is covered by an enrollee's health
plan company, health insurer, or health coverage plan; or
(3) expressed personal disagreement with a decision made by
a person, organization, or health care provider regarding
treatment or coverage provided to a patient of the provider, or
assisted the patient in seeking reconsideration of such a
decision, provided the health care provider makes it clear that
the provider is acting in a personal capacity and not as a
representative of or on behalf of the entity that made the
decision.
Subd. 4. [EXCLUSION.] (a) Nothing in this section
prohibits a health plan from taking action against a provider if
the health plan has evidence that the provider's actions are
illegal, constitute medical malpractice, or are contrary to
accepted medical practices.
(b) Nothing in this section prohibits a contract provision
or directive that requires any contracting party to keep
confidential or to not use or disclose the specific amounts paid
to a provider, provider fee schedules, provider salaries, and
other proprietary information of a specific health plan or
health plan company.
Sec. 4. [62J.72] [DISCLOSURE OF HEALTH CARE PROVIDER
INFORMATION.]
Subdivision 1. [WRITTEN DISCLOSURE.] (a) A health plan
company, as defined under section 62J.70, subdivision 3, a
health care network cooperative as defined under section 62R.04,
subdivision 3, and a health care provider as defined under
section 62J.70, subdivision 2, shall, during open enrollment,
upon enrollment, and annually thereafter, provide enrollees with
a description of the general nature of the reimbursement
methodologies used by the health plan company, health insurer,
or health coverage plan to pay providers. This description may
be incorporated into the member handbook, subscriber contract,
certificate of coverage, or other written enrollee
communication. The general reimbursement methodology shall be
made available to employers at the time of open enrollment.
(b) Health plan companies and providers must, upon request,
provide an enrollee with specific information regarding the
reimbursement methodology, including, but not limited to, the
following information:
(1) a concise written description of the provider payment
plan, including any incentive plan applicable to the enrollee;
(2) a written description of any incentive to the provider
relating to the provision of health care services to enrollees,
including any compensation arrangement that is dependent on the
amount of health coverage or health care services provided to
the enrollee, or the number of referrals to or utilization of
specialists; and
(3) a written description of any incentive plan that
involves the transfer of financial risk to the health care
provider.
(c) The disclosure statement describing the general nature
of the reimbursement methodologies must comply with the
Readability of Insurance Policies Act in chapter 72C.
Notwithstanding any other law to the contrary, the disclosure
statement may voluntarily be filed with the commissioner for
approval.
(d) A disclosure statement that has voluntarily been filed
with the commissioner for approval under chapter 72C or
voluntarily filed with the commissioner for approval for
purposes other than pursuant to chapter 72C is deemed approved
30 days after the date of filing, unless approved or disapproved
by the commissioner on or before the end of that 30-day period.
(e) The disclosure statement describing the general nature
of the reimbursement methodologies must be provided upon request
in English, Spanish, Vietnamese, and Hmong. In addition,
reasonable efforts must be made to provide information contained
in the disclosure statement to other non-English-speaking
enrollees.
(f) Health plan companies and providers may enter into
agreements to determine how to respond to enrollee requests
received by either the provider or the health plan company.
This subdivision does not require disclosure of specific amounts
paid to a provider, provider fee schedules, provider salaries,
or other proprietary information of a specific health plan
company or health insurer or health coverage plan or provider.
Subd. 2. [ADDITIONAL WRITTEN DISCLOSURE OF PROVIDER
INFORMATION.] In the event a health plan company prepares a
written disclosure as specified in subdivision 1, in a manner
that explicitly makes a comparison of the financial incentives
between the providers with whom it contracts, it must describe
the incentives that occur at the provider level.
Subd. 3. [INFORMATION ON PATIENTS' MEDICAL BILLS.] A
health plan company and health care provider shall provide
patients and enrollees with a copy of an explicit and
intelligible bill whenever the patient or enrollee is sent a
bill and is responsible for paying any portion of that bill.
The bills must contain descriptive language sufficient to be
understood by the average patient or enrollee. This subdivision
does not apply to a flat co-pay paid by the patient or enrollee
at the time the service is required.
Subd. 4. [NONAPPLICABILITY.] Health care providers as
defined in section 62J.70, subdivision 2, clause (1), need not
individually provide information required under this section if
it has been provided by another individual or entity that is
subject to this section.
Sec. 5. [62J.73] [PROHIBITION ON EXCLUSIVE ARRANGEMENTS.]
Subdivision 1. [PROHIBITION ON EXCLUSIVE
RELATIONSHIPS.] No provider, group of providers, or health plan
company shall restrict a person's right to provide health
services or procedures to another provider, group of providers,
or health plan company, unless the person is an employee.
Subd. 2. [PROHIBITION ON RESTRICTIVE CONTRACT TERMS.] No
provider, group of providers, or person providing goods or
health services to a provider shall enter into a contract or
subcontract with a health plan company or group of providers on
terms that require the provider, group of providers, or person
not to contract with another health plan company, unless the
provider or person is an employee.
Subd. 3. [PROHIBITION REGARDING ESSENTIAL FACILITIES AND
SERVICES.] (a) No health plan company, provider, or group of
providers may withhold from its competitors health care
services, which are essential for competition between health
care providers within the meaning of the essential facilities
doctrine as interpreted by the federal courts.
(b) This subdivision should be construed as an instruction
to state court in interpreting federal law.
Subd. 4. [VIOLATIONS.] Any provider or other individual
who believes provisions of this section may have been violated
may file a complaint with the attorney general's office
regarding a possible violation of this section.
Sec. 6. [62J.74] [ENFORCEMENT.]
Subdivision 1. [AUTHORITY.] The commissioners of health
and commerce shall each periodically review contracts and
arrangements among health care providing entities and health
plan companies they regulate to determine compliance with
sections 62J.70 to 62J.73. Any person may submit a contract or
arrangement to the relevant commissioner for review if the
person believes sections 62J.70 to 62J.73 have been violated.
Any provision of a contract or arrangement found by the relevant
commissioner to violate this section is null and void, and the
relevant commissioner may assess civil penalties against the
health plan company in an amount not to exceed $2,500 for each
day the contract or arrangement is in effect, and may use the
enforcement procedures otherwise available to the commissioner.
All due process rights afforded under chapter 14 apply to this
section.
Subd. 2. [ASSISTANCE TO LICENSING BOARDS.] A
health-related licensing board as defined under section 214.01,
subdivision 2, shall submit a contract or arrangement to the
relevant commissioner for review if the board believes sections
62J.70 to 62J.73 have been violated. If the commissioner
determines that any provision of a contract or arrangement
violates those sections, the board may take disciplinary action
against any person who is licensed or regulated by the board who
entered into the contract arrangement.
Sec. 7. [62J.75] [CONSUMER ADVISORY BOARD.]
(a) The consumer advisory board consists of 18 members
appointed in accordance with paragraph (b). All members must be
public, consumer members who:
(1) do not have and never had a material interest in either
the provision of health care services or in an activity directly
related to the provision of health care services, such as health
insurance sales or health plan administration;
(2) are not registered lobbyists; and
(3) are not currently responsible for or directly involved
in the purchasing of health insurance for a business or
organization.
(b) The governor, the speaker of the house of
representatives, and the subcommittee on committees of the
committee on rules and administration of the senate shall each
appoint two members. The Indian affairs council, the council on
affairs of Chicano/Latino people, the council on Black
Minnesotans, the council on Asian-Pacific Minnesotans,
mid-Minnesota legal assistance, and the Minnesota chamber of
commerce shall each appoint one member. The member appointed by
the Minnesota chamber of commerce must represent small business
interests. The health care campaign of Minnesota, Minnesotans
for affordable health care, and consortium for citizens with
disabilities shall each appoint two members. Members serve
without compensation or reimbursement for expenses.
(c) The board shall advise the commissioners of health and
commerce on the following: (1) the needs of health care
consumers and how to better serve and educate the consumers on
health care concerns and recommend solutions to identified
problems; and (2) consumer protection issues in the self-insured
market, including, but not limited to, public education needs.
The board also may make recommendations to the legislature
on these issues.
(d) The board and this section expire June 30, 2001.
Sec. 8. [62J.76] [NONPREEMPTION.]
Nothing in the Patient Protection Act preempts or replaces
requirements related to patient protections that are more
protective of patient rights than the requirements established
by the Patient Protection Act.
Sec. 9. Minnesota Statutes 1996, section 62Q.105,
subdivision 1, is amended to read:
Subdivision 1. [ESTABLISHMENT.] Each health plan company
shall establish and make available to enrollees, by July 1, 1997
1998, an informal complaint resolution process that meets the
requirements of this section. A health plan company must make
reasonable efforts to resolve enrollee complaints, and must
inform complainants in writing of the company's decision within
30 days of receiving the complaint. The complaint resolution
process must treat the complaint and information related to it
as required under sections 72A.49 to 72A.505.
Sec. 10. Minnesota Statutes 1996, section 62Q.30, is
amended to read:
62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION
PROCESS.]
The commissioner shall establish an expedited fact finding
and dispute resolution process to assist enrollees of health
plan companies with contested treatment, coverage, and service
issues to be in effect July 1, 1997 1998. The commissioner may
order an integrated service network or an all-payer insurer to
provide or pay for a service that is within the standard health
coverage. If the disputed issue relates to whether a service is
appropriate and necessary, the commissioner shall issue an order
only after consulting with appropriate experts knowledgeable,
trained, and practicing in the area in dispute, reviewing
pertinent literature, and considering the availability of
satisfactory alternatives. The commissioner shall take steps
including but not limited to fining, suspending, or revoking the
license of a health plan company that is the subject of repeated
orders by the commissioner that suggests a pattern of
inappropriate underutilization.
Sec. 11. [62Q.55] [EMERGENCY SERVICES.]
(a) Enrollees have the right to available and accessible
emergency services, 24 hours a day and seven days a week. The
health plan company shall inform its enrollees how to obtain
emergency care and, if prior authorization for emergency
services is required, shall make available a toll-free number,
which is answered 24 hours a day, to answer questions about
emergency services and to receive reports and provide
authorizations, where appropriate, for treatment of emergency
medical conditions. Emergency services shall be covered whether
provided by participating or nonparticipating providers and
whether provided within or outside the health plan company's
service area. In reviewing a denial for coverage of emergency
services, the health plan company shall take the following
factors into consideration:
(1) a reasonable layperson's belief that the circumstances
required immediate medical care that could not wait until the
next working day or next available clinic appointment;
(2) the time of day and day of the week the care was
provided;
(3) the presenting symptoms, including, but not limited to,
severe pain, to ensure that the decision to reimburse the
emergency care is not made solely on the basis of the actual
diagnosis;
(4) the enrollee's efforts to follow the health plan
company's established procedures for obtaining emergency care;
and
(5) any circumstances that precluded use of the health plan
company's established procedures for obtaining emergency care.
(b) The health plan company may require enrollees to notify
the health plan company of nonreferred emergency care as soon as
possible, but not later than 48 hours, after the emergency care
is initially provided. However, emergency care which would have
been covered under the contract had notice been provided within
the set time frame must be covered.
(c) Notwithstanding paragraphs (a) and (b), a health plan
company, health insurer, or health coverage plan that is in
compliance with the rules regarding accessibility of services
adopted under section 62D.20 is in compliance with this section.
Sec. 12. [62Q.56] [CONTINUITY OF CARE.]
Subdivision 1. [CHANGE IN HEALTH CARE PROVIDER.] (a) If
enrollees are required to access services through selected
primary care providers for coverage, the health plan company
shall prepare a written plan that provides for continuity of
care in the event of contract termination between the health
plan company and any of the contracted primary care providers or
general hospital providers. The written plan must explain:
(1) how the health plan company will inform affected
enrollees, insureds, or beneficiaries about termination at least
30 days before the termination is effective, if the health plan
company or health care network cooperative has received at least
120 days' prior notice;
(2) how the health plan company will inform the affected
enrollees about what other participating providers are available
to assume care and how it will facilitate an orderly transfer of
its enrollees from the terminating provider to the new provider
to maintain continuity of care;
(3) the procedures by which enrollees will be transferred
to other participating providers, when special medical needs,
special risks, or other special circumstances, such as cultural
or language barriers, require them to have a longer transition
period or be transferred to nonparticipating providers;
(4) who will identify enrollees with special medical needs
or at special risk and what criteria will be used for this
determination; and
(5) how continuity of care will be provided for enrollees
identified as having special needs or at special risk, and
whether the health plan company has assigned this responsibility
to its contracted primary care providers.
(b) If the contract termination was not for cause,
enrollees can request a referral to the terminating provider for
up to 120 days if they have special medical needs or have other
special circumstances, such as cultural or language barriers.
The health plan company can require medical records and other
supporting documentation in support of the requested referral.
Each request for referral to a terminating provider shall be
considered by the health plan company on a case-by-case basis.
(c) If the contract termination was for cause, enrollees
must be notified of the change and transferred to participating
providers in a timely manner so that health care services remain
available and accessible to the affected enrollees. The health
plan company is not required to refer an enrollee back to the
terminating provider if the termination was for cause.
Subd. 2. [CHANGE IN HEALTH PLANS.] (a) The health plan
company shall prepare a written plan that provides a process for
coverage determinations for continuity of care for new enrollees
with special needs, special risks, or other special
circumstances, such as cultural or language barriers, who
request continuity of care with their former provider for up to
120 days. The written plan must explain the criteria that will
be used for determining special needs cases, and how continuity
of care will be provided.
(b) This subdivision applies only to group coverage and
continuation and conversion coverage, and applies only to
changes in health plans made by the employer.
Subd. 3. [DISCLOSURES.] The written plans required under
this section must be made available upon request to enrollees or
prospective enrollees.
Sec. 13. [62Q.58] [ACCESS TO SPECIALTY CARE.]
Subdivision 1. [STANDING REFERRAL.] A health plan company
shall establish a procedure by which an enrollee may apply for a
standing referral to a health care provider who is a specialist
if a referral to a specialist is required for coverage. This
procedure for a standing referral must specify the necessary
criteria and conditions, which must be met in order for an
enrollee to obtain a standing referral.
Subd. 2. [COORDINATION OF SERVICES.] A primary care
provider or primary care group shall remain responsible for
coordinating the care of an enrollee who has received a standing
referral to a specialist. The specialist shall not make any
secondary referrals related to primary care services without
prior approval by the primary care provider or primary care
group. However, an enrollee with a standing referral to a
specialist may request primary care services from that
specialist. The specialist, in agreement with the enrollee and
primary care provider or primary care group, may elect to
provide primary care services to that enrollee according to
procedures established by the health plan company.
Subd. 3. [DISCLOSURE.] Information regarding referral
procedures must be included in member contracts or certificates
of coverage and must be provided to an enrollee or prospective
enrollee by a health plan company upon request.
Sec. 14. [62Q.64] [DISCLOSURE OF EXECUTIVE COMPENSATION.]
(a) Each health plan company doing business in this state
shall annually file with the consumer advisory board created in
section 62J.75:
(1) a copy of the health plan company's form 990 filed with
the federal Internal Revenue Service; or
(2) if the health plan company did not file a form 990 with
the federal Internal Revenue Service, a list of the amount and
recipients of the health plan company's five highest salaries,
including all types of compensation, in excess of $50,000.
(b) A filing under this section is public data under
section 13.03.
Sec. 15. [144.6585] [IDENTIFICATION OF HEALTH CARE
PROVIDERS.]
Any health care provider who is licensed, credentialed, or
registered by a health-related licensing board as defined under
section 214.01, subdivision 2, must wear a name tag that
indicates by words, letters, abbreviations, or insignia the
profession or occupation of the individual. The name tag must
be worn whenever the health care provider is rendering health
services to a patient, unless wearing the name tag would create
a safety or health risk to the patient. The failure to wear a
name tag is not reportable under chapter 214.
Sec. 16. Minnesota Statutes 1996, section 181.932,
subdivision 1, is amended to read:
Subdivision 1. [PROHIBITED ACTION.] An employer shall not
discharge, discipline, threaten, otherwise discriminate against,
or penalize an employee regarding the employee's compensation,
terms, conditions, location, or privileges of employment because:
(a) the employee, or a person acting on behalf of an
employee, in good faith, reports a violation or suspected
violation of any federal or state law or rule adopted pursuant
to law to an employer or to any governmental body or law
enforcement official;
(b) the employee is requested by a public body or office to
participate in an investigation, hearing, inquiry; or
(c) the employee refuses an employer's order to perform an
action that the employee has an objective basis in fact to
believe violates any state or federal law or rule or regulation
adopted pursuant to law, and the employee informs the employer
that the order is being refused for that reason; or
(d) the employee, in good faith, reports a situation in
which the quality of health care services provided by a health
care facility, organization, or health care provider violates a
standard established by federal or state law or a professionally
recognized national clinical or ethical standard and potentially
places the public at risk of harm.
Sec. 17. Minnesota Statutes 1996, section 214.16,
subdivision 1, is amended to read:
Subdivision 1. [DEFINITIONS.] For purposes of this
section, the following terms have the meanings given them.
(a) "Board" means the boards of medical practice,
chiropractic examiners, nursing, optometry, dentistry, pharmacy,
psychology, social work, marriage and family therapy, and
podiatry.
(b) "Regulated person" means a licensed physician,
chiropractor, nurse, optometrist, dentist,
pharmacist, psychologist, social worker, marriage and family
therapist, or podiatrist.
Sec. 18. Minnesota Statutes 1996, section 214.16,
subdivision 3, is amended to read:
Subd. 3. [GROUNDS FOR DISCIPLINARY ACTION.] The board
shall take disciplinary action, which may include license
revocation, against a regulated person for:
(1) intentional failure to provide the commissioner of
health with the data required under chapter 62J;
(2) intentional failure to provide the commissioner of
revenue with data on gross revenue and other information
required for the commissioner to implement sections 295.50 to
295.58; and
(3) intentional failure to pay the health care provider tax
required under section 295.52; and
(4) entering into a contract or arrangement that is
prohibited under sections 62J.70 to 62J.73.
Sec. 19. [CONSOLIDATION AND COORDINATION OF CONSUMER
ASSISTANCE AND ADVOCACY OFFICES.]
The commissioners of health and commerce, in consultation
with the commissioners of human services and employee relations,
shall study the feasibility and desirability of consolidating
and improving coordination of some or all existing state
consumer assistance, ombudsperson, and advocacy activities. The
commissioners shall submit a report with recommendations, and
draft legislation to the legislature by January 15, 1998.
Sec. 20. [COMPLAINT PROCESS STUDY.]
The commissioners of health and commerce, in consultation
with the consumer advisory board and other affected parties,
shall make recommendations to the legislature by January 15,
1998, on developing a complaint resolution process for health
plan companies to make available for enrollees.
Sec. 21. [CONSIDERATION.]
The consumer advisory board shall consider the use of
physicians by utilization review organizations, including
whether only Minnesota licensed physicians should be used for
utilization review, whether appropriate types of medical
practitioners are being used for utilization review, and whether
Minnesota's utilization review statutes afford adequate consumer
protection. The consumer advisory board may report findings to
the legislature prior to the 1998 legislative session.
Sec. 22. [REPEALER; ANTITRUST EXEMPTION PROCESS.]
Minnesota Statutes 1996, sections 62J.2911, 62J.2912,
62J.2913, 62J.2914, 62J.2915, 62J.2916, 62J.2917, 62J.2918,
62J.2919, 62J.2920, and 62J.2921 are repealed.
Sec. 23. [EFFECTIVE DATE.]
Sections 3, 17, and 18 are effective January 1, 1998, and
apply to contracts entered into or renewed on or after the
effective date. Sections 1, 7 to 10, 16, 20, and 22 are
effective the day following final enactment. Sections 4, 11,
12, and 13 are effective January 1, 1998, and apply to contracts
or coverage issued or renewed on or after the effective date.
Presented to the governor May 29, 1997
Signed by the governor June 2, 1997, 2:22 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes