1.1                          A bill for an act
  1.2             relating to health; providing for patient protection; 
  1.3             prohibiting retaliation and certain provider 
  1.4             contracts; requiring certain disclosures; modifying 
  1.5             provisions of the consumer advisory board; requiring a 
  1.6             study; amending Minnesota Statutes 1996, section 
  1.7             62M.09, subdivision 6; Minnesota Statutes 1997 
  1.8             Supplement, sections 62J.75; and 62M.09, subdivision 
  1.9             3; proposing coding for new law in Minnesota Statutes, 
  1.10            chapter 62J; repealing Minnesota Statutes 1997 
  1.11            Supplement, sections 62J.71; and 62J.72. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13     Section 1.  [62J.711] [RETALIATION AND PROVIDER CONTRACTS.] 
  1.14     Subdivision 1.  [RETALIATORY ACTION PROHIBITED.] No health 
  1.15  plan company may take retaliatory action against a provider 
  1.16  solely on the grounds that the provider: 
  1.17     (1) disseminated accurate information regarding coverage of 
  1.18  benefits or accurate benefit limitations of an enrollee's 
  1.19  contract or accurately interpreted provisions of the provider 
  1.20  agreement that limit prescribing, providing, or ordering care; 
  1.21     (2) criticized coverage or any other aspect of a health 
  1.22  plan; 
  1.23     (3) made a recommendation regarding the suitability or 
  1.24  desirability of a health plan for a patient; 
  1.25     (4) discussed diagnostic, treatment, or referral options 
  1.26  that are not covered or are limited by the health plan; 
  1.27     (5) advocated with a health plan company on behalf of a 
  1.28  patient; 
  2.1      (6) disclosed to a patient the financial incentives 
  2.2   contained in a health plan's provider agreement; or 
  2.3      (7) provided testimony, supported or opposed legislation, 
  2.4   or made any other contact with state or federal legislators or 
  2.5   legislative staff or with state or federal executive branch 
  2.6   officers or staff. 
  2.7      Subd. 2.  [PROHIBITED AGREEMENTS AND DIRECTIVES.] No health 
  2.8   plan company may enter into a provider agreement or issue a 
  2.9   directive that prohibits a provider from engaging in activities 
  2.10  listed in subdivision 1. 
  2.11     Sec. 2.  [62J.721] [DISCLOSURE OF CERTAIN FINANCIAL 
  2.12  ARRANGEMENTS.] 
  2.13     Subdivision 1.  [WRITTEN DISCLOSURE BY HEALTH PLAN 
  2.14  COMPANY.] No health plan company shall offer, sell, issue, or 
  2.15  renew a health plan, as defined in section 62Q.01, subdivision 
  2.16  3, to an enrollee or prospective enrollee without providing to 
  2.17  the enrollee or prospective enrollee a disclosure statement that 
  2.18  meets the requirements of subdivision 2.  The disclosure 
  2.19  statement must be provided to enrollees at least annually.  
  2.20     Subd. 2.  [CONTENTS AND FORM OF DISCLOSURE.] (a) The 
  2.21  disclosure statement required in subdivision 1 must disclose and 
  2.22  explain clearly to the enrollee or prospective enrollee any 
  2.23  financial arrangements between the health plan company and any 
  2.24  health care provider that in any way make it advantageous for 
  2.25  the health care provider to minimize or restrict health care 
  2.26  provided to enrollees under the health plan.  Financial 
  2.27  arrangements to which this section applies include, but are not 
  2.28  limited to, capitation, withhold arrangements, utilization 
  2.29  standards used to evaluate health care providers, arrangements 
  2.30  in which health care providers are subject to terms of 
  2.31  compensation or contract renewal in a future time period that 
  2.32  penalize the health care providers for providing care to 
  2.33  enrollees in the current time period, and any other arrangement 
  2.34  that may have the potential to create a conflict between the 
  2.35  best interest of the enrollee and the best interest of the 
  2.36  health care provider.  Financial arrangements with health care 
  3.1   providers who are employed by the health plan company, or by an 
  3.2   affiliate, are subject to this section.  
  3.3      (b) The disclosure statement must comply with the 
  3.4   Readability of Insurance Policies Act in chapter 72C and be 
  3.5   approved by the commissioner prior to its use.  A disclosure 
  3.6   statement that has been filed with the commissioner for approval 
  3.7   is deemed approved 30 days after the date of filing unless 
  3.8   approved or disapproved by the commissioner on or before the end 
  3.9   of that 30-day period. 
  3.10     (c) The health plan company must make the disclosure 
  3.11  statement available in a language other than English if the 
  3.12  health plan company has at least 1,000 enrollees who are 
  3.13  non-English speaking persons for whom that other language is the 
  3.14  principal language.  For purposes of this paragraph, a 
  3.15  "non-English speaking person" means a person who, by reason of 
  3.16  place of birth or culture, speaks a language other than English 
  3.17  and does not speak English well enough to communicate 
  3.18  effectively in consumer transactions.  Each health plan company 
  3.19  shall file with the commissioner for approval a plan to 
  3.20  determine which languages other than English, if any, meet the 
  3.21  requirements of this paragraph for that health plan company's 
  3.22  enrollees.  The commissioner shall either approve the plan as 
  3.23  submitted or, in consultation with the health plan company, 
  3.24  approve it only after modifying it as necessary to ensure that 
  3.25  the health plan company will have sufficient information to 
  3.26  comply with this paragraph.  The health plan company shall carry 
  3.27  out the plan as approved. 
  3.28     (d) For purposes of this section: 
  3.29     (1) "capitation" means a financial arrangement in which a 
  3.30  health plan company compensates a health care provider, 
  3.31  partially or entirely, through a fixed payment per time period 
  3.32  per enrollee served by that health care provider, without regard 
  3.33  to the services actually provided to enrollees by that health 
  3.34  care provider.  The services covered by the capitation may 
  3.35  include the health care provider's own services, referral 
  3.36  services, or all health care services; 
  4.1      (2) "financial arrangement" means an agreement between a 
  4.2   health plan company, or an affiliate of it, and a health care 
  4.3   provider, or an affiliate of it, that determines, or provides a 
  4.4   methodology for determining, the payments to be made by the 
  4.5   health plan company to the health care provider for providing 
  4.6   health care to the health plan company's enrollees; 
  4.7      (3) "affiliate" has the meaning given in section 60D.15, 
  4.8   subdivision 2; and 
  4.9      (4) "withhold" means a financial arrangement in which a 
  4.10  health plan company deducts amounts from its payments to a 
  4.11  health care provider, where the deducted amounts or a portion of 
  4.12  them may eventually be paid to the health care provider at the 
  4.13  end of a specified time period, based upon specific 
  4.14  predetermined factors. 
  4.15     Subd. 3.  [EXEMPTION.] A health plan company that does not 
  4.16  use any arrangement described in subdivision 2 in connection 
  4.17  with a health plan may apply to the commissioner for an 
  4.18  exemption from subdivision 1 with respect to that health plan.  
  4.19  If the commissioner grants the exemption, the health plan 
  4.20  company need not provide a disclosure statement with respect to 
  4.21  that health plan. 
  4.22     Subd. 4.  [GROUP HEALTH PLANS.] With respect to group 
  4.23  health plans, the health plan company must comply with 
  4.24  subdivision 1 by providing the disclosure statement to the group 
  4.25  policyholder or prospective group policyholder and by requiring 
  4.26  the group policyholder to provide the disclosure statement to 
  4.27  each enrollee or prospective enrollee prior to initial 
  4.28  enrollment, at each renewal of the group health plan, and at 
  4.29  each open enrollment period.  Any literature prepared by the 
  4.30  health plan company for distribution to prospective enrollees 
  4.31  must contain the disclosure statement.  The health plan company 
  4.32  shall retain in its files, for purposes of compliance audits, 
  4.33  proof that the health plan company and group policyholder 
  4.34  complied with this subdivision. 
  4.35     Subd. 5.  [FAMILY COVERAGE.] With respect to family 
  4.36  coverage, the disclosure statement required under this section 
  5.1   must be provided to the enrollee to whom the policy, contract, 
  5.2   or certificate is issued or is to be issued and need not be 
  5.3   provided to enrollees or prospective enrollees who are that 
  5.4   person's dependents. 
  5.5      Subd. 6.  [ORAL DISCLOSURE BY PROVIDER.] At an enrollee's 
  5.6   first visit to a health care provider, a provider shall orally 
  5.7   disclose, and answer any questions regarding, the information 
  5.8   specified in subdivision 2.  A provider may designate one or 
  5.9   more persons in the provider's office or organization to meet 
  5.10  with enrollees and perform this function.  Upon completion of 
  5.11  the requirement of this subdivision, the enrollee and the person 
  5.12  providing the disclosure shall each sign a statement certifying 
  5.13  completion of the disclosure.  The provider shall retain these 
  5.14  statements in its files. 
  5.15     Sec. 3.  Minnesota Statutes 1997 Supplement, section 
  5.16  62J.75, is amended to read: 
  5.17     62J.75 [CONSUMER ADVISORY BOARD.] 
  5.18     (a) The consumer advisory board consists of 18 27 members 
  5.19  appointed in accordance with paragraph (b).  All members must be 
  5.20  public, consumer members who: 
  5.21     (1) do not have and never had a material interest in either 
  5.22  the provision of health care services or in an activity directly 
  5.23  related to the provision of health care services, such as health 
  5.24  insurance sales or health plan administration; 
  5.25     (2) are not registered lobbyists; and 
  5.26     (3) are not currently responsible for or directly involved 
  5.27  in the purchasing of health insurance for a business or 
  5.28  organization. 
  5.29     (b) The governor, the speaker of the house of 
  5.30  representatives, and the subcommittee on committees of the 
  5.31  committee on rules and administration of the senate shall each 
  5.32  appoint two members.  The Indian affairs council, the council on 
  5.33  affairs of Chicano/Latino people, the council on Black 
  5.34  Minnesotans, the council on Asian-Pacific Minnesotans, 
  5.35  mid-Minnesota legal assistance, and the Minnesota chamber of 
  5.36  commerce shall each appoint one member.  The member appointed by 
  6.1   the Minnesota chamber of commerce must represent small business 
  6.2   interests.  The health care campaign of Minnesota, Minnesotans 
  6.3   for affordable health care, and consortium for citizens with 
  6.4   disabilities shall each appoint two members.  The Minnesota 
  6.5   senior federation, the American association of retired persons, 
  6.6   and the board on aging shall each appoint three members.  
  6.7   Members serve without compensation or reimbursement for expenses.
  6.8      (c) The board shall advise the commissioners of health and 
  6.9   commerce on the following: 
  6.10     (1) the needs of health care consumers and how to better 
  6.11  serve and educate the consumers on health care concerns and 
  6.12  recommend solutions to identified problems; and 
  6.13     (2) consumer protection issues in the self-insured market, 
  6.14  including, but not limited to, public education needs. 
  6.15     The board also may make recommendations to the legislature 
  6.16  on these issues. 
  6.17     (d) The board and this section expire June 30, 2001. 
  6.18     Sec. 4.  Minnesota Statutes 1997 Supplement, section 
  6.19  62M.09, subdivision 3, is amended to read: 
  6.20     Subd. 3.  [PHYSICIAN REVIEWER INVOLVEMENT.] A physician 
  6.21  licensed in this state must review all cases in which the 
  6.22  utilization review organization has concluded that a 
  6.23  determination not to certify for clinical reasons is 
  6.24  appropriate.  The physician should be reasonably available by 
  6.25  telephone to discuss the determination with the attending 
  6.26  physician.  This subdivision does not apply to outpatient mental 
  6.27  health or substance abuse services governed by subdivision 3a.  
  6.28     Sec. 5.  Minnesota Statutes 1996, section 62M.09, 
  6.29  subdivision 6, is amended to read: 
  6.30     Subd. 6.  [PHYSICIAN CONSULTANTS.] A utilization review 
  6.31  organization must use physician consultants in the appeal 
  6.32  process described in section 62M.06, subdivision 3.  The 
  6.33  physician consultants must be licensed in this state and should 
  6.34  include, as needed and available, specialists who are 
  6.35  board-certified, or board-eligible and working towards 
  6.36  certification, in a specialty board approved by the American 
  7.1   Board of Medical Specialists or the American Board of Osteopathy.
  7.2      Sec. 6.  [HEALTH COVERAGE COMPETITION STUDY.] 
  7.3      The commissioners of commerce and health and the attorney 
  7.4   general shall study the extent of, and factors affecting, 
  7.5   competition in the market for health coverage in this state and 
  7.6   recommend legislation to promote competition in the market.  The 
  7.7   recommendations must be submitted in a written report to the 
  7.8   legislature no later than January 15, 1999. 
  7.9      Sec. 7.  [REPEALER.] 
  7.10     Minnesota Statutes 1997 Supplement, sections 62J.71; and 
  7.11  62J.72, are repealed. 
  7.12     Sec. 8.  [EFFECTIVE DATE.] 
  7.13     Sections 1, 2, 4, and 5 are effective January 1, 1999.