62Q.22 HEALTH CARE SERVICES PREPAID OPTION.
Subdivision 1. Scope.
A community health clinic that is designated as an essential community provider under section
and is associated with a hospital, a governmental unit, or the University of Minnesota may offer to individuals and families
the option of purchasing basic health care services on a fixed prepaid basis without satisfying the requirements of chapter
60A, 62A, 62C, or 62D, or any other law or rule that applies to entities licensed under those chapters.
Subd. 2. Registration.
A community health clinic that offers a prepaid option under this section must register on an annual basis with the commissioner
Subd. 3. Premiums.
The premiums for a prepaid option offered under this section must be based on a sliding fee schedule based on current poverty
Subd. 4. Health care services.
(a) A prepaid option offered under this section must provide basic health care services including:(1) services for the diagnosis and treatment of injuries, illnesses, or conditions;(2) child health supervision services up to age 18, as defined under section
(3) preventive health services, including:(i) health education;(ii) health supervision, evaluation, and follow-up;(iii) immunization; and(iv) early disease detection.(b) Inpatient hospital services shall not be offered as a part of a community health clinic's prepaid option. A clinic may
associate with a hospital to provide hospital services to an individual or family who is enrolled in the prepaid option so
long as these services are not offered as part of the prepaid option.(c) All health care services included by the community health clinic in a prepaid option must be services that are offered
within the scope of practice of the clinic by the clinic's professional staff.
Subd. 5. Guaranteed renewability.
A community health clinic shall not refuse to renew a prepaid option, except for nonpayment of premiums, fraud, or misrepresentation,
or as permitted under subdivisions 8 and 9, paragraph (b).
Subd. 6. Information to be provided.
(a) A community health clinic must provide an individual or family who purchases a prepaid option a clear and concise written
statement that includes the following information:(1) the health care services that the prepaid option covers;(2) any exclusions or limitations on the health care services offered, including any preexisting condition limitations, cost-sharing
arrangements, or prior authorization requirements;(3) where the health care services may be obtained;(4) a description of the clinic's method for resolving patient complaints, including a description of how a patient can file
a complaint with the Department of Health; and(5) a description of the conditions under which the prepaid option may be canceled or terminated.(b) The commissioner of health must approve a copy of the written statement before the community health clinic may offer the
prepaid option described in this section.
Subd. 7. Complaint process.
(a) A community health clinic that offers a prepaid option under this section must establish a complaint resolution process.
As an alternative to establishing its own process, a community health clinic may use the complaint process of another organization.(b) A community health clinic must make reasonable efforts to resolve complaints and to inform complainants in writing of
the clinic's decision within 60 days of receiving the complaint.(c) A community health clinic that offers a prepaid option under this section must report all complaints that are not resolved
within 60 days to the commissioner of health.
Subd. 8. Public assistance program eligibility.
A community health clinic may require an individual or family enrolled in the clinic's prepaid option to apply for medical
assistance, general assistance medical care, or the MinnesotaCare program. The clinic must assist the individual or family
in filing the application for the appropriate public program. If, upon the request of the clinic, an individual or family
refuses to apply for these programs, the clinic may disenroll the individual or family from the prepaid option at any time.
Subd. 9. Limitations on enrollment.
(a) A community health clinic may limit enrollment in its prepaid option. If enrollment is limited, a waiting list must be
established.(b) A community health clinic may deny enrollment in its prepaid option to an individual or family whose gross family income
is greater than 275 percent of the federal poverty guidelines.(c) No community health clinic may restrict or deny enrollment in its prepaid option because of an individual's or a family's
financial limitations, except as permitted under this subdivision.
History: 1997 c 194 s 1