language to be deleted (2) new language
CHAPTER 94-S.F.No. 673 An act relating to health plans; regulating contract stacking; providing a remedy; proposing coding for new law in Minnesota Statutes, chapter 62Q. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. [62Q.74] [NETWORK SHADOW CONTRACTING.] Subdivision 1. [DEFINITIONS.] (a) For purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Category of coverage" means one of the following types of health-related coverage: (1) health; (2) no-fault automobile medical benefits; or (3) workers' compensation medical benefits. (c) "Health care provider" or "provider" has the meaning given in section 148.01. (d) "Network organization" means a preferred provider organization as defined in section 145.61, subdivision 4c; a managed care organization as defined in section 62Q.01, subdivision 5; or other entity that uses or consists of a network of health care providers; but does not include a nonprofit health service plan corporation operating under chapter 62C or its affiliates. Subd. 2. [PROVIDER CONSENT REQUIRED.] (a) No network organization shall require a health care provider to participate in a network under a category of coverage that differs from the category or categories of coverage to which the existing contract between the network organization and the provider applies, without the consent of the provider obtained under subdivision 3. (b) This section does not apply to situations in which the network organization wishes the provider to participate in a new or different plan or other arrangement within a category of coverage that is already provided for in an existing contract between the network organization and the provider. (c) Compliance with this section may not be waived in a contract or otherwise. Subd. 3. [CONSENT PROCEDURE.] (a) The network organization, if it wishes to apply an existing contract with a provider to a different category of coverage, shall first notify the provider in writing. The written notice must include at least the following: (1) the network organization's name, address, and telephone number, and the name of the specific network, if it differs from that of the network organization; (2) a description of the proposed new category of coverage; (3) the names of all payers expected by the network organization to use the network for the new category of coverage; (4) the approximate number of current enrollees of the network organization in that category of coverage within the provider's geographical area; (5) a disclosure of all contract terms of the proposed new category of coverage, including the discount or reduced fees, care guidelines, utilization review criteria, prior authorization process, and dispute resolution process; (6) a form for the provider's convenience in accepting or declining participation in the proposed new category of coverage, provided that the provider need not use that form in responding; and (7) a statement informing the provider of the provisions of paragraph (b). (b) If the provider does not decline participation within 30 days after the postmark date of the notice, the provider is deemed to have accepted the proposed new category of coverage. Subd. 4. [CONTRACT TERMINATION RESTRICTED.] A network organization must not terminate an existing contract with a provider, or fail to honor the contract in good faith, based solely on the provider's decision not to accept a proposed new category of coverage. The most recent agreed-upon contractual obligations remain in force until the existing contract's renewal or termination date. Subd. 5. [REMEDY.] If a network organization violates this section by reimbursing a provider as if the provider had agreed under this section to participate in the network under a category of coverage to which the provider has not agreed, the provider has a cause of action against the network organization to recover two times the difference between the reasonable charges for claims affected by the violation and the amounts actually paid to the provider. The provider is also entitled to recover costs, disbursements, and reasonable attorney fees. Sec. 2. [EFFECTIVE DATE.] Section 1 is effective for contracts entered into or renewed after August 1, 1999. Presented to the governor April 20, 1999 Signed by the governor April 23, 1999, 11:17 a.m.