Office of the Revisor of Statutes
Minnesota Session Laws - 2001, Regular Session
Key: (1) language to be deleted (2) new language
CHAPTER 170-H.F.No. 1155
An act relating to insurance; requiring health plan
companies to provide certain information when
requested by the commissioner; requiring an
affirmative provider consent to participate in a
network under a category of coverage; requiring
disclosure of changes in a provider's contract;
establishing a moratorium on managed care automobile
insurance plans; defining health benefit plan for
certain purposes; establishing a task force on small
business health insurance; repealing the requirement
for an action plan; removing a penalty; amending
Minnesota Statutes 2000, sections 62D.08, subdivision
5; 62N.25, subdivision 7; 62Q.19, subdivision 1;
62Q.74, subdivisions 2, 3; 256B.692, subdivision 2;
proposing coding for new law in Minnesota Statutes,
chapter 62Q; repealing Minnesota Statutes 2000,
section 62Q.07.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1. Minnesota Statutes 2000, section 62D.08,
subdivision 5, is amended to read:
Subd. 5. [CHANGES IN PARTICIPATING ENTITIES; PENALTY.]
Every health maintenance organization shall inform the
commissioner of any change in the information described in
section 62D.03, subdivision 4, clause (e), including any change
in address, any modification of the duration of any contract or
agreement, and any addition to the list of participating
entities, within ten working days of the notification of the
change. Any cancellation or discontinuance of any contract or
agreement listed in section 62D.03, subdivision 4, clause (e),
or listed subsequently in accordance with this subdivision,
shall be reported to the commissioner 120 days before the
effective date. When the health maintenance organization
terminates a provider for cause, death, disability, or loss of
license, the health maintenance organization must notify the
commissioner within three ten working days of the date the
health maintenance organization sends out or receives the notice
of cancellation, discontinuance, or termination. Any health
maintenance organization which fails to notify the commissioner
within the time periods prescribed in this subdivision shall be
subject to the levy of a fine up to $200 per contract for each
day the notice is past due, accruing up to the date the
organization notifies the commissioner of the cancellation or
discontinuance. Any fine levied under this subdivision is
subject to the contested case and judicial review provisions of
chapter 14. The levy of a fine does not preclude the
commissioner from using other penalties described in sections
62D.15 to 62D.17.
Sec. 2. Minnesota Statutes 2000, section 62N.25,
subdivision 7, is amended to read:
Subd. 7. [EXEMPTIONS FROM EXISTING REQUIREMENTS.]
Community integrated service networks are exempt from the
following requirements applicable to health maintenance
organizations:
(1) conducting focused studies under Minnesota Rules, part
4685.1125;
(2) preparing and filing, as a condition of licensure, a
written quality assurance plan, and annually filing such a plan
and a work plan, under Minnesota Rules, parts 4685.1110 and
4685.1130;
(3) maintaining statistics under Minnesota Rules, part
4685.1200;
(4) filing provider contract forms under sections 62D.03,
subdivision 4, and 62D.08, subdivision 1; and
(5) reporting any changes in the address of a network
provider or length of a provider contract or additions to the
provider network to the commissioner within ten days under
section 62D.08, subdivision 5. Community networks must report
such information to the commissioner on a quarterly basis.
Community networks that fail to make the required quarterly
filing are subject to the penalties set forth in section 62D.08,
subdivision 5; and
(6) preparing and filing, as a condition of licensure, a
marketing plan, and annually filing a marketing plan, under
sections 62D.03, subdivision 4, paragraph (l), and 62D.08,
subdivision 1.
Sec. 3. Minnesota Statutes 2000, section 62Q.19,
subdivision 1, is amended to read:
Subdivision 1. [DESIGNATION.] The commissioner shall
designate essential community providers. The criteria for
essential community provider designation shall be the following:
(1) a demonstrated ability to integrate applicable
supportive and stabilizing services with medical care for
uninsured persons and high-risk and special needs populations as
defined in section 62Q.07, subdivision 2, paragraph (e),
underserved, and other special needs populations; and
(2) a commitment to serve low-income and underserved
populations by meeting the following requirements:
(i) has nonprofit status in accordance with chapter 317A;
(ii) has tax exempt status in accordance with the Internal
Revenue Service Code, section 501(c)(3);
(iii) charges for services on a sliding fee schedule based
on current poverty income guidelines; and
(iv) does not restrict access or services because of a
client's financial limitation;
(3) status as a local government unit as defined in section
62D.02, subdivision 11, a hospital district created or
reorganized under sections 447.31 to 447.37, an Indian tribal
government, an Indian health service unit, or a community health
board as defined in chapter 145A;
(4) a former state hospital that specializes in the
treatment of cerebral palsy, spina bifida, epilepsy, closed head
injuries, specialized orthopedic problems, and other disabling
conditions; or
(5) a rural hospital that has qualified for a sole
community hospital financial assistance grant in the past three
years under section 144.1484, subdivision 1. For these rural
hospitals, the essential community provider designation applies
to all health services provided, including both inpatient and
outpatient services.
Prior to designation, the commissioner shall publish the
names of all applicants in the State Register. The public shall
have 30 days from the date of publication to submit written
comments to the commissioner on the application. No designation
shall be made by the commissioner until the 30-day period has
expired.
The commissioner may designate an eligible provider as an
essential community provider for all the services offered by
that provider or for specific services designated by the
commissioner.
For the purpose of this subdivision, supportive and
stabilizing services include at a minimum, transportation, child
care, cultural, and linguistic services where appropriate.
Sec. 4. Minnesota Statutes 2000, section 62Q.74,
subdivision 2, is amended to read:
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 affirmative 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.
Sec. 5. Minnesota Statutes 2000, section 62Q.74,
subdivision 3, is amended to read:
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 Unless the provider has affirmatively agreed to
participate within 60 days after the postmark date of the
notice, the provider is deemed to have not accepted the proposed
new category of coverage.
Sec. 6. [62Q.745] [PROVIDER CONTRACT AMENDMENT
DISCLOSURE.]
(a) Any amendment or change in the terms of an existing
contract between a network organization and a health care
provider must be disclosed to the provider.
(b) Any amendment or change in the contract that alters the
financial reimbursement or alters the written contractual
policies and procedures governing the relationship between the
provider and the network organization must be disclosed to the
provider before the amendment or change is deemed to be in
effect.
(c) For purposes of this section, "network organization"
and "health care provider" or "provider" have the meanings given
in section 62Q.74.
Sec. 7. [62Q.746] [ACCESS TO CERTAIN INFORMATION REGARDING
PROVIDERS.]
Upon request of the commissioner, a health plan company
licensed under chapters 62C and 62D, must provide the following
information:
(1) a detailed description of the health plan company's
methods and procedures, standards, qualifications, criteria, and
credentialing requirements for designating the providers who are
eligible to participate in the health plan company's provider
network, including any limitations on the numbers of providers
to be included in the network;
(2) the number of full-time equivalent physicians, by
specialty, nonphysician providers, and allied health providers
used to provide services; and
(3) summary data that is broken down by type of provider,
reflecting actual utilization of network and non-network
practitioners and allied professionals by enrollees of the
health plan company.
Sec. 8. Minnesota Statutes 2000, section 256B.692,
subdivision 2, is amended to read:
Subd. 2. [DUTIES OF THE COMMISSIONER OF HEALTH.] (a)
Notwithstanding chapters 62D and 62N, a county that elects to
purchase medical assistance and general assistance medical care
in return for a fixed sum without regard to the frequency or
extent of services furnished to any particular enrollee is not
required to obtain a certificate of authority under chapter 62D
or 62N. The county board of commissioners is the governing body
of a county-based purchasing program. In a multicounty
arrangement, the governing body is a joint powers board
established under section 471.59.
(b) A county that elects to purchase medical assistance and
general assistance medical care services under this section must
satisfy the commissioner of health that the requirements for
assurance of consumer protection, provider protection, and
fiscal solvency of chapter 62D, applicable to health maintenance
organizations, or chapter 62N, applicable to community
integrated service networks, will be met.
(c) A county must also assure the commissioner of health
that the requirements of sections 62J.041; 62J.48; 62J.71 to
62J.73; 62M.01 to 62M.16; all applicable provisions of chapter
62Q, including sections 62Q.07; 62Q.075; 62Q.1055; 62Q.106;
62Q.12; 62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c);
62Q.43; 62Q.47; 62Q.50; 62Q.52 to 62Q.56; 62Q.58; 62Q.64; 62Q.68
to 62Q.72; and 72A.201 will be met.
(d) All enforcement and rulemaking powers available under
chapters 62D, 62J, 62M, 62N, and 62Q are hereby granted to the
commissioner of health with respect to counties that purchase
medical assistance and general assistance medical care services
under this section.
(e) The commissioner, in consultation with county
government, shall develop administrative and financial reporting
requirements for county-based purchasing programs relating to
sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and
62N.31, and other sections as necessary, that are specific to
county administrative, accounting, and reporting systems and
consistent with other statutory requirements of counties.
Sec. 9. [TASK FORCE ON SMALL BUSINESS HEALTH INSURANCE.]
(a) The task force on small business health insurance shall
study Minnesota's health coverage market available to small
businesses and make recommendations for solutions that could
make group health coverage more accessible and affordable for
small businesses. The task force shall recommend any
legislative changes needed to permit those solutions.
(b) The task force shall report its recommendations in
writing to the legislature, in compliance with Minnesota
Statutes, section 3.195, no later than December 15, 2001.
(c) The commissioners of commerce and health shall provide
any necessary assistance to the task force.
(d) The task force consists of the following members:
(1) three members of the senate, including at least one
member of the minority, appointed by the subcommittee on
committees of the senate committee on rules and administration;
(2) three members of the house, including at least one
member of the minority, appointed by the speaker of the house;
(3) four persons representing small business owners, three
appointed by the Minnesota chamber of commerce and one appointed
by the national federation of independent business;
(4) two persons appointed by the Minnesota council of
health plans;
(5) one person appointed by the insurance federation of
Minnesota;
(6) one insurance agent, appointed by the Minnesota
association of health underwriters;
(7) the commissioner of commerce or the commissioner's
designee; and
(8) four consumers appointed by the commissioner, two of
whom must reside outside the metropolitan area as defined in
Minnesota Statutes, section 473.121, subdivision 2.
(e) The task force shall not provide compensation or
expense reimbursement to its members.
(f) The task force expires on June 30, 2002.
Sec. 10. [MORATORIUM.]
Subdivision 1. [MORATORIUM ON NEW MANAGED CARE AUTOMOBILE
INSURANCE PLANS.] No automobile insurance company licensed under
Minnesota Statutes, chapter 60A, and authorized to provide
automobile no-fault coverage or any health plan company as
defined under Minnesota Statutes, section 62Q.01, subdivision 4,
may enter into any contracts that provide, or that have the
effect of providing, managed care services to no-fault claimants
between January 1, 2001, and June 30, 2002. 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. This subdivision may not be construed to impact the
legality of the use of managed care services for no-fault
benefits.
Subd. 2. [EXISTING MANAGED CARE CONTRACTS.] Any health
plan company or automobile insurer that is party to a contract
subject to the moratorium set forth in subdivision 1, in
existence prior to the moratorium created on January 1, 2001,
must comply with the following provisions during the moratorium
created under this act:
(1) no such contract shall be extended to any additional
insurers; and
(2) if a provider has declined to participate in a category
of coverage, the network organization must permit the provider
the opportunity to participate in that category of coverage on a
biennial basis.
Subd. 3. [SUNSET.] This section is repealed effective June
30, 2002.
Sec. 11. [REPEALER.]
Minnesota Statutes 2000, section 62Q.07, is repealed.
Sec. 12. [EFFECTIVE DATE.]
Sections 1, 2, 3, 8, 9, 10, and 11 are effective the day
following final enactment.
Presented to the governor May 21, 2001
Signed by the governor May 24, 2001, 1:56 p.m.
Official Publication of the State of Minnesota
Revisor of Statutes