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Office of the Revisor of Statutes

(a) As a condition of doing business in Minnesota, each health insurer shall comply with
the requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including
any federal regulations adopted under that act, to the extent that it imposes a requirement that
applies in this state and that is not also required by the laws of this state. This section does not
require compliance with any provision of the federal act prior to the effective date provided for
that provision in the federal act. The commissioner shall enforce this section.
For the purpose of this section, "health insurer" includes self-insured plans, group health
plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974),
service benefit plans, managed care organizations, pharmacy benefit managers, or other parties
that are by contract legally responsible to pay a claim for a healthcare item or service for an
individual receiving benefits under paragraph (b).
(b) No health plan issued or renewed to provide coverage to a Minnesota resident shall
contain any provision denying or reducing benefits because services are rendered to a person who
is eligible for or receiving medical benefits pursuant to title XIX of the Social Security Act
(Medicaid) in this or any other state; chapter 256; 256B; or 256D or services pursuant to section
252.27; 256L.01 to 256L.10; 260B.331, subdivision 2; 260C.331, subdivision 2; or 393.07,
subdivision 1
or 2. No health carrier providing benefits under plans covered by this section
shall use eligibility for medical programs named in this section as an underwriting guideline or
reason for nonacceptance of the risk.
(c) If payment for covered expenses has been made under state medical programs for health
care items or services provided to an individual, and a third party has a legal liability to make
payments, the rights of payment and appeal of an adverse coverage decision for the individual, or
in the case of a child their responsible relative or caretaker, will be subrogated to the state agency.
The state agency may assert its rights under this section within three years of the date the service
was rendered. For purposes of this section, "state agency" includes prepaid health plans under
contract with the commissioner according to sections 256B.69, 256D.03, subdivision 4, paragraph
(c), and 256L.12; children's mental health collaboratives under section 245.493; demonstration
projects for persons with disabilities under section 256B.77; nursing homes under the alternative
payment demonstration project under section 256B.434; and county-based purchasing entities
under section 256B.692.
(d) Notwithstanding any law to the contrary, when a person covered by a health plan receives
medical benefits according to any statute listed in this section, payment for covered services or
notice of denial for services billed by the provider must be issued directly to the provider. If a
person was receiving medical benefits through the Department of Human Services at the time
a service was provided, the provider must indicate this benefit coverage on any claim forms
submitted by the provider to the health carrier for those services. If the commissioner of human
services notifies the health carrier that the commissioner has made payments to the provider,
payment for benefits or notices of denials issued by the health carrier must be issued directly to the
commissioner. Submission by the department to the health carrier of the claim on a Department
of Human Services claim form is proper notice and shall be considered proof of payment of the
claim to the provider and supersedes any contract requirements of the health carrier relating
to the form of submission. Liability to the insured for coverage is satisfied to the extent that
payments for those benefits are made by the health carrier to the provider or the commissioner
as required by this section.
(e) When a state agency has acquired the rights of an individual eligible for medical
programs named in this section and has health benefits coverage through a health carrier, the
health carrier shall not impose requirements that are different from requirements applicable to an
agent or assignee of any other individual covered.
(f) For the purpose of this section, health plan includes coverage offered by community
integrated service networks, any plan governed under the federal Employee Retirement Income
Security Act of 1974 (ERISA), United States Code, title 29, sections 1001 to 1461, and coverage
offered under the exclusions listed in section 62A.011, subdivision 3, clauses (2), (6), (9), (10),
and (12).
History: 1975 c 247 s 1; 1979 c 174 s 1; 1989 c 282 art 3 s 1; 1990 c 426 art 2 s 2; 1992 c
549 art 4 s 19; 1Sp1993 c 1 art 5 s 1; 1995 c 207 art 10 s 1; 1997 c 225 art 2 s 62; 1999 c 139 art
4 s 2; 1999 c 245 art 4 s 1; 2004 c 228 art 1 s 75; 2006 c 282 art 17 s 1