1.1                          A bill for an act 
  1.2             relating to health care; creating a statewide health 
  1.3             care consumer assistance program; prohibiting 
  1.4             contracts that restrict communication between 
  1.5             providers and their patients; requiring disclosure of 
  1.6             health care provider financial incentives; requiring 
  1.7             health plan companies to provide continuity of care 
  1.8             and access to specialty care for certain enrollees; 
  1.9             prohibiting certain exclusive arrangements; 
  1.10            appropriating money; amending Minnesota Statutes 1996, 
  1.11            sections 62Q.01, by adding subdivisions; 62Q.105; 
  1.12            62Q.106; 62Q.30; 181.932, subdivision 1; and 214.16, 
  1.13            subdivisions 1 and 3; proposing coding for new law in 
  1.14            Minnesota Statutes, chapters 62J; 62Q; and 144; 
  1.15            repealing Minnesota Statutes 1996, section 62Q.11. 
  1.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.17     Section 1.  [62J.70] [PATIENT PROTECTION.] 
  1.18     Subdivision 1.  [DEFINITION.] (a) For purposes of this 
  1.19  section, "health care provider" or "provider" means: 
  1.20     (1) a physician, nurse, or other provider as defined under 
  1.21  section 62J.03; 
  1.22     (2) a hospital as defined under section 144.696, 
  1.23  subdivision 3; and 
  1.24     (3) an association, partnership, corporation, limited 
  1.25  liability corporation, or other organization of persons or 
  1.26  entities described in clause (1) or (2) organized for the 
  1.27  purposes of providing, arranging, or administering health care 
  1.28  services or treatment.  
  1.29     (b) For purposes of this section, "patient" includes a 
  1.30  former, current, or prospective patient of a health care 
  2.1   provider.  
  2.2      This section does not apply to a trade association, 
  2.3   membership association of health care professionals, or other 
  2.4   organization that does not directly provide, arrange, or 
  2.5   administer health care services or treatment.  
  2.6      Subd. 2.  [PROHIBITED PROVIDER CONTRACTS.] The following 
  2.7   types of contracts or agreements are contrary to state public 
  2.8   policy, are prohibited under this section, and are null and void:
  2.9      (1) Any contract or written agreement that prohibits a 
  2.10  health care provider from communicating with a patient with 
  2.11  respect to the patient's health status, health care, or 
  2.12  treatment options, as long as the health care provider is acting 
  2.13  in good faith and within the provider's scope of practice as 
  2.14  defined by law. 
  2.15     (2) Any contract or written agreement that prohibits a 
  2.16  health care provider from disclosing accurate information about 
  2.17  whether services or treatment will be paid for by a patient's 
  2.18  health insurance, health coverage plan, or other third-party 
  2.19  payment arrangement. 
  2.20     (3) Any contract or written agreement that prohibits a 
  2.21  health care provider from informing a patient about the general 
  2.22  nature of the reimbursement methodology used by a health plan to 
  2.23  pay the provider, including any incentives or penalties intended 
  2.24  to encourage providers to withhold services or minimize or avoid 
  2.25  referrals to specialists. 
  2.26     Subd. 3.  [PERSONS AND ENTITIES AFFECTED.] The following 
  2.27  persons and entities shall not enter into any contract or 
  2.28  agreement that is prohibited under this section: 
  2.29     (1) a health plan company; 
  2.30     (2) a health care network cooperative as defined under 
  2.31  section 62R.04, subdivision 3; 
  2.32     (3) a health care provider as defined in subdivision 1; or 
  2.33     (4) any other individual or entity that delivers, arranges, 
  2.34  or administers health care services or treatment or administers 
  2.35  a health coverage plan.  
  2.36     Subd. 4.  [RETALIATION PROHIBITED.] No person or 
  3.1   organization that has a contract with a health care provider may 
  3.2   take retaliatory action against the provider solely on the 
  3.3   grounds that the provider: 
  3.4      (1) refused to enter into a contract or agreement that is 
  3.5   prohibited under this section; 
  3.6      (2) disclosed accurate information about whether a health 
  3.7   care service or treatment is covered by a patient's health 
  3.8   insurance or health coverage plan; 
  3.9      (3) expressed disagreement with a health plan's decision to 
  3.10  deny or limit services or benefits to a patient or in a public 
  3.11  forum; 
  3.12     (4) assisted a patient in seeking reconsideration of a 
  3.13  health plan decision to deny or limit services or benefits; or 
  3.14     (5) offered a personal recommendation to a patient 
  3.15  regarding the selection of a health plan based on the provider's 
  3.16  personal knowledge of the health needs of a patient. 
  3.17     Sec. 2.  [62J.72] [DISCLOSURE OF PROVIDER FINANCIAL 
  3.18  INCENTIVES.] 
  3.19     Subdivision 1.  [DISCLOSURE.] A health plan company, a 
  3.20  health care network cooperative as defined under section 62R.04, 
  3.21  subdivision 3, a health care provider as defined under section 
  3.22  62J.70, subdivision 1, and any other individual or entity that 
  3.23  administers a health coverage plan shall, upon request, disclose 
  3.24  to their enrollees, subscribers, insureds, or patients the 
  3.25  general nature of the reimbursement methodology used by a health 
  3.26  plan to pay a provider.  This information must be in writing and 
  3.27  must include a description of: 
  3.28     (1) any penalty or incentive used to encourage a provider 
  3.29  to withhold services or minimize or avoid referrals to 
  3.30  specialists; and 
  3.31     (2) any compensation arrangement that is dependent on 
  3.32  limiting health care coverage or health care services such as 
  3.33  requiring a provider to meet a specific number or a targeted 
  3.34  average or setting a maximum duration for patient services. 
  3.35     Subd. 2.  [DIRECT-MARKETING MATERIALS.] If direct-marketing 
  3.36  materials are used by any of the entities identified in 
  4.1   subdivision 1, the information described in subdivision 1 must 
  4.2   be included. 
  4.3      Subd. 3.  [ENROLLEE INFORMATION.] Entities identified in 
  4.4   subdivision 1 must provide their enrollees, subscribers, or 
  4.5   insureds with the information described in subdivision 1 as part 
  4.6   of the evidence of coverage, contract, or policy provided to 
  4.7   their enrollees, subscribers, or insureds. 
  4.8      Sec. 3.  [62J.74] [HEALTH CARE CONSUMER ASSISTANCE 
  4.9   PROGRAM.] 
  4.10     Subdivision 1.  [ESTABLISHMENT.] The commissioners of 
  4.11  health and commerce, in consultation with the commissioners of 
  4.12  human services and employee relations, shall establish a 
  4.13  statewide program to provide assistance to consumers or patients 
  4.14  with complaints or problems relating to their health care or 
  4.15  health coverage plan.  The program shall include a statewide 
  4.16  toll-free telephone number.  
  4.17     Subd. 2.  [SELECTION CRITERIA.] The commissioner of 
  4.18  administration shall contract with an agency, organization, or a 
  4.19  consortium of organizations to operate the health care consumer 
  4.20  assistance program.  The commissioner shall not contract with an 
  4.21  agency, organization, or consortium that:  
  4.22     (1) has a direct involvement in the licensing, 
  4.23  certification, or accreditation of a health care facility, 
  4.24  health plan company, or health care provider; 
  4.25     (2) has a direct ownership or financial interest in a 
  4.26  health care facility, health plan company, or in providing, 
  4.27  arranging, or administering health care services or treatment; 
  4.28  or 
  4.29     (3) is employed by or is under contract to provide 
  4.30  management services to a health care facility, health plan 
  4.31  company, or an entity that provides, arranges, or administers 
  4.32  health care services or treatment.  
  4.33     Subd. 3.  [FUNCTIONS.] The health care consumer assistance 
  4.34  program shall provide assistance to all health care consumers: 
  4.35     (1) in understanding their health care program or health 
  4.36  coverage plan; 
  5.1      (2) in selecting a health plan; 
  5.2      (3) in obtaining information on health plan and health care 
  5.3   provider performances; 
  5.4      (4) in locating the appropriate agency or person to provide 
  5.5   further assistance if needed; and 
  5.6      (5) in understanding their contractual and legal rights, 
  5.7   including their rights under the dispute resolution process and 
  5.8   in assisting in exercising these rights. 
  5.9      Sec. 4.  Minnesota Statutes 1996, section 62Q.01, is 
  5.10  amended by adding a subdivision to read: 
  5.11     Subd. 7.  [ALTERNATIVE DISPUTE RESOLUTION.] "Alternative 
  5.12  dispute resolution" means the methods listed and defined in 
  5.13  Minnesota General Rules of Practice, rule 114. 
  5.14     Sec. 5.  Minnesota Statutes 1996, section 62Q.01, is 
  5.15  amended by adding a subdivision to read: 
  5.16     Subd. 8.  [BINDING ALTERNATIVE DISPUTE RESOLUTION.] 
  5.17  "Binding alternative dispute resolution" means that parties 
  5.18  using alternative dispute resolution agree to be bound by the 
  5.19  outcome, and may not file suit in district court unless 
  5.20  otherwise permitted by law. 
  5.21     Sec. 6.  Minnesota Statutes 1996, section 62Q.01, is 
  5.22  amended by adding a subdivision to read: 
  5.23     Subd. 9.  [COMPLAINT.] "Complaint" means a written 
  5.24  grievance by, or on behalf of, an applicant, enrollee, or former 
  5.25  enrollee against the health plan company or its participating 
  5.26  providers. 
  5.27     Sec. 7.  Minnesota Statutes 1996, section 62Q.01, is 
  5.28  amended by adding a subdivision to read: 
  5.29     Subd. 10.  [COMPLAINANT.] "Complainant" means an applicant, 
  5.30  enrollee or former enrollee, or anyone legally authorized to act 
  5.31  on behalf of an applicant, enrollee, or former enrollee who 
  5.32  submits a complaint. 
  5.33     Sec. 8.  Minnesota Statutes 1996, section 62Q.01, is 
  5.34  amended by adding a subdivision to read: 
  5.35     Subd. 11.  [INTERNAL APPEAL.] "Internal appeal" means a 
  5.36  health plan company's reconsideration of either its initial 
  6.1   response to a complaint or a determination by the commissioner 
  6.2   in response to a complaint.  An internal appeal may include a 
  6.3   hearing if requested by the complainant, and must be conducted 
  6.4   not solely by the same person who made the initial response to 
  6.5   the complaint. 
  6.6      Sec. 9.  Minnesota Statutes 1996, section 62Q.01, is 
  6.7   amended by adding a subdivision to read: 
  6.8      Subd. 12.  [MEDICALLY URGENT COMPLAINT.] "Medically urgent 
  6.9   complaint" means a complaint about denial of coverage of health 
  6.10  care that:  (1) is not an emergency, but a reasonable person 
  6.11  would believe is needed as soon as possible to protect the 
  6.12  health of the enrollee; and (2) has not been provided.  A 
  6.13  medically urgent complaint need not be in writing. 
  6.14     Sec. 10.  Minnesota Statutes 1996, section 62Q.01, is 
  6.15  amended by adding a subdivision to read: 
  6.16     Subd. 13.  [EXPEDITED REVIEW.] "Expedited review" means the 
  6.17  expedited fact finding and dispute resolution process used by 
  6.18  the commissioner to resolve medically urgent complaints reported 
  6.19  to the commissioner. 
  6.20     Sec. 11.  Minnesota Statutes 1996, section 62Q.105, is 
  6.21  amended to read: 
  6.22     62Q.105 [HEALTH PLAN COMPANY COMPLAINT PROCEDURE.] 
  6.23     Subdivision 1.  [ESTABLISHMENT.] Each health plan company 
  6.24  shall establish and make available to enrollees, by July 1, 
  6.25  1997, an informal complaint resolution process that meets the 
  6.26  requirements of this section.  A health plan company must make 
  6.27  reasonable efforts to resolve enrollee complaints, and must 
  6.28  inform complainants in writing of the company's decision and the 
  6.29  reasons for it within 30 days of receiving the complaint.  The 
  6.30  complaint resolution process must treat the complaint and 
  6.31  information related to it as required under sections 72A.49 to 
  6.32  72A.505. 
  6.33     Subd. 2.  [MEDICALLY URGENT COMPLAINTS.] Health plan 
  6.34  companies shall make reasonable efforts to promptly resolve 
  6.35  medically urgent ~~enrollee~~ complaints ~~within 72 hours~~ and 
  6.36  promptly notify the complainant and the commissioner of their 
  7.1   decisions by the end of the next business day after the 
  7.2   complaint is registered, but in no case later than two business 
  7.3   days of receiving the complaint. 
  7.4      Subd. 3.  [APPEALS PROCESS.] Health plan companies shall 
  7.5   establish and make available to ~~enrollees~~ complainants an 
  7.6   ~~impartial~~ internal appeals process.  If a decision by a health 
  7.7   plan company regarding a complaint is partially or wholly 
  7.8   adverse to the complainant, the health plan company shall advise 
  7.9   the complainant of ~~the right to~~ additional appeal ~~through the~~ 
  7.10  ~~impartial appeals process or to the commissioner.~~ mechanisms 
  7.11  under this section.  The health plan company shall also advise 
  7.12  complainants of the right to appeal decisions not to certify 
  7.13  under section 62M.06 through the health plan company's internal 
  7.14  appeals process.  The person or persons conducting the appeal 
  7.15  must have the authority to resolve or recommend the resolution 
  7.16  of the complaint and must not be solely the person or persons 
  7.17  who decided the complainant's original complaint.  A health plan 
  7.18  company must inform the complainant of the outcome of an 
  7.19  internal appeal in writing, and the reasons for it, within 45 
  7.20  days of receiving the appeal.  A health plan company must 
  7.21  explain Medicare appeal procedures to its Medicare 
  7.22  complainants.  For persons enrolled in health care programs 
  7.23  established under section 256.9363, 256B.69, or 256D.03, a 
  7.24  health plan company must explain how to contact the managed care 
  7.25  ombudsperson at the department of human services and how to 
  7.26  appeal to the commissioner of human services. 
  7.27     Subd. 4.  [ALTERNATIVE DISPUTE RESOLUTION.] Health plan 
  7.28  companies shall make available to ~~enrollees~~ complainants an 
  7.29  alternative dispute resolution process according to subdivision 
  7.30  10 to appeal health plan company internal appeal decisions, and 
  7.31  shall participate in that alternative dispute resolution at the 
  7.32  request of ~~an enrollee, as required under section 62Q.11~~ the 
  7.33  complainant.  A health plan company must respond within 14 days 
  7.34  of receiving the complainant's request for alternative dispute 
  7.35  resolution and inform the enrollee of the options available.  A 
  7.36  health plan company may meet the requirements of subdivision 3 
  8.1   by providing an alternative dispute resolution process~~.  If the~~ 
  8.2   ~~health plan company chooses to provide alternative dispute~~ 
  8.3   ~~resolution to meet the requirements of subdivision 3, the~~ 
  8.4   ~~process shall be provided~~ at no cost to the ~~enrollee~~ complainant.
  8.5      Subd. 5.  [REQUIREMENTS FOR MANAGED CARE ORGANIZATIONS.] 
  8.6   Each managed care organization shall submit all health care 
  8.7   quality related complaints to its quality review board or 
  8.8   quality review organization for evaluation and possible action.  
  8.9   The complaint resolution process for managed care organizations 
  8.10  must clearly indicate the entity responsible for resolving 
  8.11  complaints made by ~~enrollees~~ complainants against hospitals, 
  8.12  other health care facilities, and health care providers, that 
  8.13  are owned by or under contract with the managed care 
  8.14  organization. 
  8.15     Subd. 6.  [RECORDKEEPING.] Health plan companies shall 
  8.16  maintain records of all ~~enrollee~~ complaints and their 
  8.17  resolutions.  These records must be retained for five years, and 
  8.18  must be made available to the ~~appropriate~~ commissioner upon 
  8.19  request. 
  8.20     Subd. 7.  [REPORTING.] Each health plan company shall 
  8.21  submit to the ~~appropriate~~ commissioner, as part of the company's 
  8.22  annual filing, data on the number and type of complaints that 
  8.23  are not resolved within 30 days.  A health plan company shall 
  8.24  also make this information available to the public upon request. 
  8.25     Subd. 8.  [NOTICE TO ENROLLEES.] Health plan companies 
  8.26  shall provide a clear and complete description of their 
  8.27  complaint resolution procedures to enrollees as part of their 
  8.28  evidence of coverage or contract and at any time a claim is 
  8.29  denied.  The description must specifically inform enrollees: 
  8.30     (1) how to file a complaint with the health plan company; 
  8.31     (2) how to request an ~~impartial~~ internal appeal; 
  8.32     (3) how to appeal to or file a complaint with the 
  8.33  commissioner and that they have the right to request the use of 
  8.34  an alternative ~~methods~~ method of dispute resolution following an 
  8.35  internal appeal; and 
  8.36     (4) that they have the right to litigate. 
  9.1      Subd. 9.  [PROCEDURE.] (a) When a complainant files a 
  9.2   complaint with the health plan company and receives the written 
  9.3   response to the complaint, the complainant may appeal through 
  9.4   the health plan company's internal appeal process. 
  9.5      (b) When a complainant files a complaint with the 
  9.6   commissioner, the commissioner shall investigate the complaint 
  9.7   and inform the complainant and the health plan company of the 
  9.8   commissioner's decision.  A complainant who receives the 
  9.9   commissioner's decision may proceed under subdivision 3. 
  9.10     (c) A complainant may appeal the result of the health plan 
  9.11  company's internal appeal process to the commissioner or to 
  9.12  alternative dispute resolution. 
  9.13     (d) Procedures under this section are stayed when a 
  9.14  complainant files suit, including suit in conciliation court, 
  9.15  against a health plan company, or when the complainant makes the 
  9.16  health plan company a party to the complainant's suit against 
  9.17  another party concerning the facts giving rise to the 
  9.18  complaint.  Upon a decision on the merits, the complainant shall 
  9.19  be deemed to have waived the remedies under this section.  If a 
  9.20  complainant's case is dismissed for reasons other than on the 
  9.21  merits or if the complainant and health plan company agree, a 
  9.22  complainant may access the procedures under this section. 
  9.23     Subd. 10.  [DISPUTE RESOLUTION.] (a) Alternative dispute 
  9.24  resolution is nonbinding, unless the parties mutually agree in 
  9.25  writing that alternative dispute resolution is binding. 
  9.26     (b) Complaints regarding employer initiated actions, agent 
  9.27  misrepresentation, or premiums are not subject to alternative 
  9.28  dispute resolution.  A medical malpractice damage claim is not 
  9.29  subject to alternative dispute resolution unless agreed to by 
  9.30  all parties subsequent to the event giving rise to the claim. 
  9.31     (c) A health plan company shall inform and educate its 
  9.32  enrollees about alternative dispute resolution and its benefits. 
  9.33     (d) The complainant and the health plan company shall 
  9.34  mutually agree to the alternative dispute method to resolve the 
  9.35  complainant's appeal and the alternative dispute resolution 
  9.36  neutral within 14 days of the complainant's receipt of 
 10.1   alternative dispute resolution options.  Arbitration shall be 
 10.2   used if the complainant and the health plan company cannot 
 10.3   agree.  If the parties cannot agree on an alternative dispute 
 10.4   resolution neutral, they must contact the commissioner who shall 
 10.5   appoint a neutral.  The alternative dispute resolution must be 
 10.6   scheduled as soon as possible after the parties agree to a 
 10.7   method.  The alternative dispute resolution neutral must inform 
 10.8   the complainant and the health plan company of the outcome of an 
 10.9   alternative dispute resolution in writing, and the reasons for 
 10.10  it.  For purposes of this subdivision, "neutral" is defined as 
 10.11  an individual or organization who provides an alternative 
 10.12  dispute resolution process.  
 10.13     (e) The commissioners of health and commerce shall 
 10.14  establish appropriate cost-sharing requirements for parties 
 10.15  taking part in alternative dispute resolution. 
 10.16     Subd. 11.  [PROVIDER DISPUTE RESOLUTION.] When a health 
 10.17  care provider under a contract has a dispute with a health plan 
 10.18  company that is governed neither by the federal Health Care 
 10.19  Quality Improvement Act of 1986, United States Code, title 42, 
 10.20  sections 11101 to 11152, nor by a contract between the provider 
 10.21  and the health plan company, the provider may request an 
 10.22  alternative dispute resolution process.  The health plan company 
 10.23  must participate.  The health care provider and the health plan 
 10.24  company shall mutually agree to one of the alternative dispute 
 10.25  resolution methods listed in subdivision 10 within 30 calendar 
 10.26  days of the health plan company receiving the request for 
 10.27  alternative dispute resolution.  If the provider and the health 
 10.28  plan company cannot agree on the alternative dispute resolution 
 10.29  method, arbitration shall be used.  Alternative dispute 
 10.30  resolution under this subdivision is binding unless the parties 
 10.31  mutually agree in writing that alternative dispute resolution is 
 10.32  not binding. 
 10.33     Sec. 12.  Minnesota Statutes 1996, section 62Q.106, is 
 10.34  amended to read: 
 10.35     62Q.106 [~~DISPUTE RESOLUTION BY COMMISSIONER~~ COMMISSIONER'S 
 10.36  RESPONSIBILITY TO INVESTIGATE COMPLAINTS.] 
 11.1      A complainant may at any time prior to binding alternative 
 11.2   dispute resolution or a judicial decision on the merits, submit 
 11.3   a complaint to the ~~appropriate~~ commissioner to investigate.  The 
 11.4   commissioner may investigate a complaint or appeal of the health 
 11.5   plan company's internal appeal decision.  When the complaint 
 11.6   concerns the health plan company's decision to not cover a 
 11.7   service, the commissioner may review the complaint and any 
 11.8   information, including testimony, necessary to resolve the 
 11.9   complaint.  After investigating a complaint, or reviewing a 
 11.10  company's decision, the ~~appropriate~~ commissioner may order a 
 11.11  remedy as authorized under section ~~62N.04,~~ 62Q.30, chapter 45, 
 11.12  60A, or 62D. 
 11.13     Sec. 13.  Minnesota Statutes 1996, section 62Q.30, is 
 11.14  amended to read: 
 11.15     62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 
 11.16  PROCESS.] 
 11.17     (a) By July 1, 1997, the commissioner shall establish an 
 11.18  expedited fact finding and dispute resolution process to ~~assist~~ 
 11.19  ~~enrollees of health plan companies with contested treatment,~~ 
 11.20  ~~coverage, and service issues to be in effect July 1,~~ 
 11.21  ~~1997~~ investigate medically urgent complaints.  
 11.22     (b) The commissioner may order ~~an integrated service~~ 
 11.23  ~~network or an all-payer insurer~~ a health plan company to provide 
 11.24  or pay for a service that is ~~within the standard health coverage~~ 
 11.25  either required by law to be covered or is covered under the 
 11.26  enrollee's evidence of coverage.  The commissioner shall take 
 11.27  steps including, but not limited to, fining, suspending, or 
 11.28  revoking the license of a health plan company that is the 
 11.29  subject of repeated orders by the commissioner that suggest a 
 11.30  pattern of failure to provide or pay for services required by 
 11.31  law to be covered or covered under an enrollee's health plan. 
 11.32     (c) If the disputed issue relates to whether a service is 
 11.33  ~~appropriate and~~ experimental or medically necessary, the 
 11.34  commissioner shall issue an order only after consulting with 
 11.35  appropriate experts knowledgeable, trained, and practicing in 
 11.36  the area in dispute, reviewing pertinent literature, and 
 12.1   considering the availability of satisfactory alternatives.  ~~The~~ 
 12.2   ~~commissioner shall take steps including but not limited to~~ 
 12.3   ~~fining, suspending, or revoking the license of a health plan~~ 
 12.4   ~~company that is the subject of repeated orders by the~~ 
 12.5   ~~commissioner that suggests a pattern of inappropriate~~ 
 12.6   ~~underutilization.~~ 
 12.7      (d) Procedures under this section are stayed when an 
 12.8   enrollee files suit, including suit in conciliation court, 
 12.9   against a health plan company or when the enrollee makes the 
 12.10  health plan company a party to the enrollee's suit against 
 12.11  another party concerning the facts giving rise to the enrollee's 
 12.12  complaint.  Upon a decision on the merits, the enrollee shall be 
 12.13  deemed to have waived the remedies under this section.  If an 
 12.14  enrollee's case is dismissed for reasons other than on the 
 12.15  merits or if the enrollee and the health plan company agree, an 
 12.16  enrollee may access the procedures under this section. 
 12.17     Sec. 14.  [62Q.56] [CONTINUITY OF CARE.] 
 12.18     Subdivision 1.  [CHANGE IN HEALTH PLANS.] (a) A health plan 
 12.19  company must provide coverage for all covered services provided 
 12.20  to a new enrollee by a health care provider who is not a member 
 12.21  of the health plan's provider network or is not under contract 
 12.22  with the health plan to provide health services if at the time 
 12.23  of enrollment the enrollee is receiving an ongoing course of 
 12.24  treatment from that health care provider and meets one of the 
 12.25  following conditions: 
 12.26     (1) has a life threatening physical condition, mental 
 12.27  condition, or chronic health condition; 
 12.28     (2) has a degenerative disease, physical disability, mental 
 12.29  illness, chronic health condition, or mental retardation and 
 12.30  other related conditions; 
 12.31     (3) has entered the second trimester of pregnancy prior to 
 12.32  the time of enrollment; 
 12.33     (4) is receiving culturally appropriate services and the 
 12.34  health plan company does not have a provider in its preferred 
 12.35  provider network with special expertise in the delivery of these 
 12.36  culturally appropriate services; or 
 13.1      (5) does not speak English and the health plan company does 
 13.2   not have a provider in its preferred provider network that 
 13.3   speaks the language spoken by the enrollee. 
 13.4      (b) This subdivision only applies to group coverage and 
 13.5   continuation and conversion coverage. 
 13.6      Subd. 2.  [CHANGE IN HEALTH CARE PROVIDER.] If a health 
 13.7   care provider's contract is terminated with a health plan 
 13.8   company for reasons other than fraud, patient abuse, 
 13.9   incompetency, or loss of licensure status, the health plan 
 13.10  company must continue to provide coverage for all covered 
 13.11  services provided by the health care provider to an enrollee of 
 13.12  the health plan if at the time of termination the provider is 
 13.13  providing services to the enrollee for an ongoing course of 
 13.14  treatment and the enrollee meets one of the following conditions:
 13.15     (1) has a life threatening physical condition, mental 
 13.16  condition, or chronic health care condition; 
 13.17     (2) has a degenerative disease, physical disability, mental 
 13.18  illness, chronic health care condition, or mental retardation 
 13.19  and other related conditions; 
 13.20     (3) has entered the second trimester of pregnancy prior to 
 13.21  the time the provider leaves the health plan's network; 
 13.22     (4) is receiving culturally appropriate services and the 
 13.23  health plan company does not have a provider in its preferred 
 13.24  provider network with special expertise in the delivery of these 
 13.25  culturally appropriate services; or 
 13.26     (5) does not speak English and the health plan company does 
 13.27  not have a provider in its preferred provider network that 
 13.28  speaks the language spoken by the enrollee.  
 13.29     Subd. 3.  [LIMITATIONS.] (a) Subdivisions 1 and 2 apply 
 13.30  only if the enrollee's health care provider agrees to: 
 13.31     (1) accept as payment in full the health plan company's 
 13.32  reimbursement rate for out-of-network providers for the same or 
 13.33  similar services; 
 13.34     (2) adhere to the health plan company's preauthorization 
 13.35  requirements; and 
 13.36     (3) provide the health plan company with all necessary 
 14.1   medical information related to the care provided to the enrollee.
 14.2      (b) An enrollee may receive coverage for all covered 
 14.3   services related to an ongoing course of treatment as described 
 14.4   in subdivisions 1 and 2 for a period of up to 120 days or 
 14.5   through postpartum if the enrollee is pregnant.  This limitation 
 14.6   may be extended upon the agreement of the health plan company, 
 14.7   health care provider, and the enrollee.  The health plan company 
 14.8   must assist the enrollee in selecting a provider within the 
 14.9   health plan company's network.  
 14.10     (c) Nothing in this section requires a health plan to 
 14.11  provide coverage for a health care service or treatment that is 
 14.12  not covered under the enrollee's health plan. 
 14.13     Sec. 15.  [62Q.58] [ACCESS TO SPECIALTY CARE.] 
 14.14     Subdivision 1.  [STANDING REFERRAL.] A health plan company 
 14.15  must establish a procedure by which enrollees may apply for, and 
 14.16  if appropriate, receive a standing referral to a health care 
 14.17  provider who is a specialist.  This procedure for a standing 
 14.18  referral must specify the necessary managed care review and 
 14.19  approval an enrollee must obtain before such a standing referral 
 14.20  is permitted. 
 14.21     Subd. 2.  [MANDATORY STANDING REFERRAL.] An enrollee who 
 14.22  requests a standing referral to a specialist must be given a 
 14.23  standing referral to an appropriate specialist if the enrollee 
 14.24  meets any of the following conditions: 
 14.25     (1) has a life threatening physical condition, mental 
 14.26  condition, or chronic health condition; 
 14.27     (2) has a degenerative disease, physical disability, mental 
 14.28  illness, chronic health condition, or mental retardation and 
 14.29  other related conditions; or 
 14.30     (3) has entered the second trimester of pregnancy and the 
 14.31  pregnancy has been assessed by the health plan as high risk.  
 14.32     Subd. 3.  [COORDINATION OF SERVICES.] An enrollee who 
 14.33  receives a standing referral under subdivision 1 or 2 may 
 14.34  request that the health plan company permit the specialist to 
 14.35  become the enrollee's primary care provider and manage all 
 14.36  medical care appropriate to the enrollee, including primary 
 15.1   care, authorization of tests and services, and all other 
 15.2   services covered under the enrollee benefit plan.  Health plan 
 15.3   companies must establish a procedure for approval of a request 
 15.4   for coordination of services through a relevant specialist.  
 15.5      Subd. 4.  [DISCLOSURE.] A clear statement of the procedures 
 15.6   established under subdivisions 1 to 3 must be included as part 
 15.7   of any direct-marketing materials provided to consumers.  
 15.8      Sec. 16.  [62Q.62] [PROHIBITION ON EXCLUSIVE ARRANGEMENTS.] 
 15.9      Subdivision 1.  [EXCLUSIVE ARRANGEMENT.] For purposes of 
 15.10  this section, "exclusive arrangement" means any agreement or 
 15.11  contract, including but not limited to, acquisition, purchase, 
 15.12  affiliation, or consulting agreements with a health plan company 
 15.13  or health care provider, which has the purpose or effect of:  
 15.14     (1) committing any person providing health care services to 
 15.15  accept and treat as patients the enrollees of a health plan 
 15.16  company to the exclusion of enrollees who have coverage through 
 15.17  any other health plan company; 
 15.18     (2) providing reimbursement on sliding scales, capitation 
 15.19  rates, payment schedules, or other payment arrangements as a 
 15.20  financial incentive for persons providing health care services 
 15.21  to restrict treatment to enrollees who have coverage through any 
 15.22  other health plan company; 
 15.23     (3) providing reimbursement on sliding scales, capitation 
 15.24  rates, payment schedules, or other payment arrangements that 
 15.25  contain a financial penalty for failing to restrict treatment to 
 15.26  enrollees who have coverage through any other health plan 
 15.27  company; 
 15.28     (4) restricting any person's right to provide health 
 15.29  services, goods, or procedures to another provider or health 
 15.30  plan company; or 
 15.31     (5) preventing any person providing goods or health care 
 15.32  services from contracting with any health plan company or 
 15.33  provider. 
 15.34     Subd. 2.  [PROHIBITION ON EXCLUSIVE ARRANGEMENTS.] No 
 15.35  provider or health plan company shall enter into any new 
 15.36  exclusive arrangement or renew an existing exclusive arrangement 
 16.1   with any person, unless the person is an employee.  No provider 
 16.2   or health plan company shall maintain any existing exclusive 
 16.3   arrangement or engage in any act or practice that would result 
 16.4   in exclusive arrangements with any person, unless that person is 
 16.5   an employee.  
 16.6      Subd. 3.  [ENFORCEMENT.] (a) The commissioners of health 
 16.7   and commerce shall each periodically review contracts and 
 16.8   arrangements among health care providing entities and health 
 16.9   plan companies they regulate to determine compliance with this 
 16.10  section.  Any person may submit a contract or arrangement to the 
 16.11  relevant commissioner for review if the person believes this 
 16.12  section has been violated.  Any provision of a contract or 
 16.13  arrangement found by the relevant commissioner to violate this 
 16.14  section is null and void, and the relevant commissioner may 
 16.15  assess civil penalties against the health plan company in an 
 16.16  amount not to exceed $2,500 for each day such contract is in 
 16.17  effect, and may use the enforcement procedures otherwise 
 16.18  available to the commissioner.  
 16.19     (b) A health-related licensing board as defined under 
 16.20  section 214.01, subdivision 2, may submit a contract or 
 16.21  arrangement to the relevant commissioner for review if the board 
 16.22  believes that the contract or arrangement violates this 
 16.23  section.  If the commissioner determines that any provision of a 
 16.24  contract or arrangement violates this section, the board may 
 16.25  take disciplinary action against any person who is licensed or 
 16.26  regulated by the board who entered into the contract or 
 16.27  arrangement.  
 16.28     Sec. 17.  [144.6585] [IDENTIFICATION OF HEALTH CARE 
 16.29  PROVIDERS.] 
 16.30     Any health care provider who is licensed, credentialed, or 
 16.31  registered by a health-related licensing board as defined under 
 16.32  section 214.01, subdivision 2, must wear a name tag that 
 16.33  indicates by words, letters, abbreviations, or insignia the 
 16.34  profession or occupation of the individual.  The name tag must 
 16.35  be worn whenever the health care provider is rendering health 
 16.36  services to a patient, unless wearing the name tag would create 
 17.1   a safety or health risk to the patient.  
 17.2      Sec. 18.  Minnesota Statutes 1996, section 181.932, 
 17.3   subdivision 1, is amended to read: 
 17.4      Subdivision 1.  [PROHIBITED ACTION.] An employer shall not 
 17.5   discharge, discipline, threaten, otherwise discriminate against, 
 17.6   or penalize an employee regarding the employee's compensation, 
 17.7   terms, conditions, location, or privileges of employment because:
 17.8      (a) the employee, or a person acting on behalf of an 
 17.9   employee, in good faith, reports a violation or suspected 
 17.10  violation of any federal or state law or rule adopted pursuant 
 17.11  to law to an employer or to any governmental body or law 
 17.12  enforcement official; 
 17.13     (b) the employee is requested by a public body or office to 
 17.14  participate in an investigation, hearing, inquiry; ~~or~~ 
 17.15     (c) the employee refuses an employer's order to perform an 
 17.16  action that the employee has an objective basis in fact to 
 17.17  believe violates any state or federal law or rule or regulation 
 17.18  adopted pursuant to law, and the employee informs the employer 
 17.19  that the order is being refused for that reason; or 
 17.20     (d) the employee, in good faith, reports a situation in 
 17.21  which the quality of the health care services provided by a 
 17.22  health care facility, organization, or health care provider 
 17.23  places the public at risk of harm. 
 17.24     Sec. 19.  Minnesota Statutes 1996, section 214.16, 
 17.25  subdivision 1, is amended to read: 
 17.26     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 17.27  section, the following terms have the meanings given them. 
 17.28     (a) "Board" means the boards of medical practice, 
 17.29  chiropractic examiners, nursing, optometry, dentistry, pharmacy, 
 17.30  psychology, social work, marriage and family therapy, and 
 17.31  podiatry. 
 17.32     (b) "Regulated person" means a licensed physician, 
 17.33  chiropractor, nurse, optometrist, dentist, pharmacist, or 
 17.34  podiatrist. 
 17.35     Sec. 20.  Minnesota Statutes 1996, section 214.16, 
 17.36  subdivision 3, is amended to read: 
 18.1      Subd. 3.  [GROUNDS FOR DISCIPLINARY ACTION.] The board 
 18.2   shall take disciplinary action, which may include license 
 18.3   revocation, against a regulated person for: 
 18.4      (1) intentional failure to provide the commissioner of 
 18.5   health with the data required under chapter 62J; 
 18.6      (2) intentional failure to provide the commissioner of 
 18.7   revenue with data on gross revenue and other information 
 18.8   required for the commissioner to implement sections 295.50 to 
 18.9   295.58; ~~and~~ 
 18.10     (3) intentional failure to pay the health care provider tax 
 18.11  required under section 295.52; and 
 18.12     (4) entering into a contract or arrangement that is 
 18.13  prohibited under section 62Q.62. 
 18.14     Sec. 21.  [CONSOLIDATION AND COORDINATION OF CONSUMER 
 18.15  ASSISTANCE AND ADVOCACY OFFICES.] 
 18.16     The commissioners of health and commerce, in consultation 
 18.17  with the commissioners of human services and employee relations, 
 18.18  shall study the feasibility and desirability of consolidating 
 18.19  and improving coordination of some or all existing state 
 18.20  consumer assistance, ombudsperson, and advocacy activities.  The 
 18.21  commissioners shall submit a report with recommendations, and 
 18.22  draft legislation to the legislature by January 15, 1998.  
 18.23     Sec. 22.  [APPROPRIATION.] 
 18.24     $....... is appropriated from the general fund to the 
 18.25  commissioner of administration to contract for the operation of 
 18.26  the health care consumer assistance program established under 
 18.27  section 3.  The appropriation is available until expended.  
 18.28     Sec. 23.  [REPEALER.] 
 18.29     Minnesota Statutes 1996, section 62Q.11, is repealed.  
 18.30     Sec. 24.  [EFFECTIVE DATE.] 
 18.31     (a) Sections 1 and 16 are effective the day following final 
 18.32  enactment. 
 18.33     (b) Section 2 is effective July 1, 1997, and the 
 18.34  information described in this section must be included in any 
 18.35  direct-marketing materials printed after this date. 
 18.36     (c) Sections 14, 17, and 18 are effective July 1, 1997. 
 19.1      (d) Section 15 is effective January 1, 1998.