1999 Minnesota Statutes

     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. 

    HIST: 1999 c 94 s 1