Minnesota Session Laws - 1998, Regular Session

                            CHAPTER 293-S.F.No. 2608 
                  An act relating to insurance; providing basic Medicare 
                  supplement plan coverage for diabetes equipment and 
                  supplies; increasing the maximum lifetime benefit for 
                  policies of the comprehensive health insurance plan; 
                  amending Minnesota Statutes 1996, section 62E.12; and 
                  Minnesota Statutes 1997 Supplement, section 62A.316. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1997 Supplement, section 
        62A.316, is amended to read: 
           62A.316 [BASIC MEDICARE SUPPLEMENT PLAN; COVERAGE.] 
           (a) The basic Medicare supplement plan must have a level of 
        coverage that will provide: 
           (1) coverage for all of the Medicare part A inpatient 
        hospital coinsurance amounts, and 100 percent of all Medicare 
        part A eligible expenses for hospitalization not covered by 
        Medicare, after satisfying the Medicare part A deductible; 
           (2) coverage for the daily copayment amount of Medicare 
        part A eligible expenses for the calendar year incurred for 
        skilled nursing facility care; 
           (3) coverage for the copayment amount of Medicare eligible 
        expenses under Medicare part B regardless of hospital 
        confinement, subject to the Medicare part B deductible amount; 
           (4) 80 percent of the hospital and medical expenses and 
        supplies incurred during travel outside the United States as a 
        result of a medical emergency; 
           (5) coverage for the reasonable cost of the first three 
        pints of blood, or equivalent quantities of packed red blood 
        cells as defined under federal regulations under Medicare parts 
        A and B, unless replaced in accordance with federal regulations; 
        and 
           (6) 100 percent of the cost of immunizations and routine 
        screening procedures for cancer screening including mammograms 
        and pap smears; and 
           (7) 80 percent of coverage for all physician prescribed 
        medically appropriate and necessary equipment and supplies used 
        in the management and treatment of diabetes.  Coverage must 
        include persons with gestational, type I, or type II diabetes. 
           (b) Only the following optional benefit riders may be added 
        to this plan: 
           (1) coverage for all of the Medicare part A inpatient 
        hospital deductible amount; 
           (2) a minimum of 80 percent of eligible medical expenses 
        and supplies not covered by Medicare part B, not to exceed any 
        charge limitation established by the Medicare program or state 
        law; 
           (3) coverage for all of the Medicare part B annual 
        deductible; 
           (4) coverage for at least 50 percent, or the equivalent of 
        50 percent, of usual and customary prescription drug expenses; 
           (5) coverage for the following preventive health services: 
           (i) an annual clinical preventive medical history and 
        physical examination that may include tests and services from 
        clause (ii) and patient education to address preventive health 
        care measures; 
           (ii) any one or a combination of the following preventive 
        screening tests or preventive services, the frequency of which 
        is considered medically appropriate: 
           (A) fecal occult blood test and/or digital rectal 
        examination; 
           (B) dipstick urinalysis for hematuria, bacteriuria, and 
        proteinuria; 
           (C) pure tone (air only) hearing screening test, 
        administered or ordered by a physician; 
           (D) serum cholesterol screening every five years; 
           (E) thyroid function test; 
           (F) diabetes screening; 
           (iii) any other tests or preventive measures determined 
        appropriate by the attending physician. 
           Reimbursement shall be for the actual charges up to 100 
        percent of the Medicare-approved amount for each service, as if 
        Medicare were to cover the service as identified in American 
        Medical Association current procedural terminology (AMA CPT) 
        codes, to a maximum of $120 annually under this benefit.  This 
        benefit shall not include payment for a procedure covered by 
        Medicare; 
           (6) coverage for services to provide short-term at-home 
        assistance with activities of daily living for those recovering 
        from an illness, injury, or surgery: 
           (i) For purposes of this benefit, the following definitions 
        apply: 
           (A) "activities of daily living" include, but are not 
        limited to, bathing, dressing, personal hygiene, transferring, 
        eating, ambulating, assistance with drugs that are normally 
        self-administered, and changing bandages or other dressings; 
           (B) "care provider" means a duly qualified or licensed home 
        health aide/homemaker, personal care aid, or nurse provided 
        through a licensed home health care agency or referred by a 
        licensed referral agency or licensed nurses registry; 
           (C) "home" means a place used by the insured as a place of 
        residence, provided that the place would qualify as a residence 
        for home health care services covered by Medicare.  A hospital 
        or skilled nursing facility shall not be considered the 
        insured's place of residence; 
           (D) "at-home recovery visit" means the period of a visit 
        required to provide at-home recovery care, without limit on the 
        duration of the visit, except each consecutive four hours in a 
        24-hour period of services provided by a care provider is one 
        visit; 
           (ii) Coverage requirements and limitations: 
           (A) at-home recovery services provided must be primarily 
        services that assist in activities of daily living; 
           (B) the insured's attending physician must certify that the 
        specific type and frequency of at-home recovery services are 
        necessary because of a condition for which a home care plan of 
        treatment was approved by Medicare; 
           (C) coverage is limited to: 
           (I) no more than the number and type of at-home recovery 
        visits certified as necessary by the insured's attending 
        physician.  The total number of at-home recovery visits shall 
        not exceed the number of Medicare-approved home care visits 
        under a Medicare-approved home care plan of treatment; 
           (II) the actual charges for each visit up to a maximum 
        reimbursement of $40 per visit; 
           (III) $1,600 per calendar year; 
           (IV) seven visits in any one week; 
           (V) care furnished on a visiting basis in the insured's 
        home; 
           (VI) services provided by a care provider as defined in 
        this section; 
           (VII) at-home recovery visits while the insured is covered 
        under the policy or certificate and not otherwise excluded; 
           (VIII) at-home recovery visits received during the period 
        the insured is receiving Medicare-approved home care services or 
        no more than eight weeks after the service date of the last 
        Medicare-approved home health care visit; 
           (iii) Coverage is excluded for: 
           (A) home care visits paid for by Medicare or other 
        government programs; and 
           (B) care provided by family members, unpaid volunteers, or 
        providers who are not care providers; 
           (7) coverage for at least 50 percent, or the equivalent of 
        50 percent, of usual and customary prescription drug expenses to 
        a maximum of $1,200 paid by the issuer annually under this 
        benefit.  An issuer of Medicare supplement insurance policies 
        that elects to offer this benefit rider shall also make 
        available coverage that contains the rider specified in clause 
        (4). 
           Sec. 2.  Minnesota Statutes 1996, section 62E.12, is 
        amended to read: 
           62E.12 [MINIMUM BENEFITS OF COMPREHENSIVE HEALTH INSURANCE 
        PLAN.] 
           The association through its comprehensive health insurance 
        plan shall offer policies which provide the benefits of a number 
        one qualified plan and a number two qualified plan, except that 
        the maximum lifetime benefit on these plans shall be 
        $1,500,000 $2,000,000, and an extended basic plan and a basic 
        Medicare plan as described in sections 62A.31 to 62A.44 and 
        62E.07.  The requirement that a policy issued by the association 
        must be a qualified plan is satisfied if the association 
        contracts with a preferred provider network and the level of 
        benefits for services provided within the network satisfies the 
        requirements of a qualified plan.  If the association uses a 
        preferred provider network, payments to nonparticipating 
        providers must meet the minimum requirements of section 72A.20, 
        subdivision 15.  They shall offer health maintenance 
        organization contracts in those areas of the state where a 
        health maintenance organization has agreed to make the coverage 
        available and has been selected as a writing carrier.  
        Notwithstanding the provisions of section 62E.06 and unless 
        those charges are billed by a provider that is part of the 
        association's preferred provider network, the state plan shall 
        exclude coverage of services of a private duty nurse other than 
        on an inpatient basis and any charges for treatment in a 
        hospital located outside of the state of Minnesota in which the 
        covered person is receiving treatment for a mental or nervous 
        disorder, unless similar treatment for the mental or nervous 
        disorder is medically necessary, unavailable in Minnesota and 
        provided upon referral by a licensed Minnesota medical 
        practitioner. 
           Sec. 3.  [EFFECTIVE DATE.] 
           Section 1 is effective for policies issued or renewed after 
        January 1, 1999.  Section 2 is effective the day following final 
        enactment. 
           Presented to the governor March 16, 1998 
           Signed by the governor March 18, 1998, 11:12 a.m.