1.1                          A bill for an act 
  1.2             relating to health; establishing patient protection 
  1.3             measures; amending Minnesota Statutes 1998, sections 
  1.4             62J.71, subdivision 3; 62J.72, by adding a 
  1.5             subdivision; 62J.73, by adding a subdivision; and 
  1.6             62Q.58, subdivisions 2, 3, and by adding a 
  1.7             subdivision; Minnesota Statutes 1999 Supplement, 
  1.8             section 256B.692, subdivision 2; proposing coding for 
  1.9             new law in Minnesota Statutes, chapters 62J; and 62Q; 
  1.10            repealing Minnesota Statutes 1998, section 62Q.56. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 1998, section 62J.71, 
  1.13  subdivision 3, is amended to read: 
  1.14     Subd. 3.  [RETALIATION PROHIBITED.] No person, health plan 
  1.15  company, or other organization may take retaliatory action 
  1.16  against a health care provider solely on the grounds that the 
  1.17  provider: 
  1.18     (1) refused to enter into an agreement or provide services 
  1.19  or information in a manner that is prohibited under this section 
  1.20  or took any of the actions listed in subdivision 1; 
  1.21     (2) disclosed accurate information about whether a health 
  1.22  care service or treatment is covered by an enrollee's health 
  1.23  plan company, health insurer, or health coverage plan; 
  1.24     (3) discussed diagnostic, treatment, or referral options 
  1.25  that are not covered or are limited by the enrollee's health 
  1.26  plan company, health insurer, or health coverage plan; 
  1.27     (4) criticized coverage of the enrollee's health plan 
  1.28  company, health insurer, or health coverage plan; ~~or~~ 
  2.1      (5) expressed personal disagreement with a decision made by 
  2.2   a person, organization, or health care provider regarding 
  2.3   treatment or coverage provided to a patient of the provider, or 
  2.4   assisted or advocated for the patient in seeking reconsideration 
  2.5   of such a decision, provided the health care provider makes it 
  2.6   clear that the provider is acting in a personal capacity and not 
  2.7   as a representative of or on behalf of the entity that made the 
  2.8   decision; or 
  2.9      (6) offered a personal recommendation to an enrollee 
  2.10  regarding the selection of a health plan based on the provider's 
  2.11  personal knowledge of the health needs of the enrollee. 
  2.12     Sec. 2.  Minnesota Statutes 1998, section 62J.72, is 
  2.13  amended by adding a subdivision to read: 
  2.14     Subd. 3a.  [INFORMATION ON SURVEYS.] A health care provider 
  2.15  shall, at the request of an enrollee, provide the enrollee with 
  2.16  a summary of any surveys or results of external surveys the 
  2.17  provider participates in, including, but not limited to, patient 
  2.18  satisfaction and patient access surveys. 
  2.19     Sec. 3.  Minnesota Statutes 1998, section 62J.73, is 
  2.20  amended by adding a subdivision to read: 
  2.21     Subd. 3a.  [PROHIBITION ON CERTAIN PAYMENT 
  2.22  ARRANGEMENTS.] No provider, group of providers, or health plan 
  2.23  company shall enter into any agreement or contract that has the 
  2.24  purpose or effect of doing either of the following, unless the 
  2.25  person is an employee: 
  2.26     (1) providing reimbursement on sliding scales, capitation 
  2.27  rates, payment schedules, or other payment arrangements as a 
  2.28  financial incentive for a person providing health care services 
  2.29  to restrict treatment to enrollees who have coverage through any 
  2.30  other health plan company; or 
  2.31     (2) providing reimbursement on sliding scales, capitation 
  2.32  rates, payment schedules, or other payment arrangements that 
  2.33  contain a financial penalty for failing to restrict treatment to 
  2.34  enrollees who have coverage through any other health plan 
  2.35  company. 
  2.36     Sec. 4.  [62J.745] [CERTIFICATE OF COMPLIANCE.] 
  3.1      Subdivision 1.  [ISSUANCE OF CERTIFICATE; USE.] No 
  3.2   department or agency of the state shall accept any bid or 
  3.3   proposal for a contract or agreement or execute any contract or 
  3.4   agreement for the provision of health care coverage or services 
  3.5   exceeding $50,000 under medical assistance, general assistance 
  3.6   medical care, state employee benefit plans, or the MinnesotaCare 
  3.7   program unless the health plan company providing the health care 
  3.8   coverage or services has received a certificate of compliance 
  3.9   issued by the commissioner.  A certificate of compliance 
  3.10  signifies that a health plan company has the contracts and 
  3.11  arrangements in place in all health plans and contracts it 
  3.12  administers or participates in to comply with sections 62J.70 to 
  3.13  62J.73, 62Q.55 to 62Q.58, and 62Q.68 to 62Q.72.  A health plan 
  3.14  company may apply for a certificate of compliance by presenting 
  3.15  to the commissioner either an adequate patient protection plan 
  3.16  that demonstrates compliance with sections 62J.70 to 62J.73, 
  3.17  62Q.55 to 62Q.58, and 62Q.68 to 62Q.72 or by submitting the 
  3.18  underlying contracts and disclosures for the commissioner to 
  3.19  review.  The commissioner shall issue a certificate of 
  3.20  compliance to a health plan company if the company's plan is 
  3.21  approved by the commissioner.  A certificate of compliance is 
  3.22  valid for two years. 
  3.23     Subd. 2.  [SUSPENSION OR REVOCATION OF CERTIFICATE.] The 
  3.24  commissioner may revoke a certificate of compliance if the 
  3.25  commissioner finds that the certificate holder has not made a 
  3.26  good faith effort to comply with sections 62J.70 to 62J.73, 
  3.27  62Q.55 to 62Q.58, and 62Q.68 to 62Q.72. 
  3.28     Subd. 3.  [REVOCATION OR VOIDING OF CONTRACT.] A department 
  3.29  or agency of the state may terminate or abridge a contract or 
  3.30  agreement with a health plan company for the provision of health 
  3.31  care coverage if the health plan company's certificate is 
  3.32  suspended or revoked based upon a failure to implement or 
  3.33  failure to make a good faith effort to implement any provision 
  3.34  of sections 62J.70 to 62J.73, 62Q.55 to 62Q.58, and 62Q.68 to 
  3.35  62Q.72.  If a contract is awarded to a person who does not have 
  3.36  a certificate of compliance, the commissioner may void the 
  4.1   contract on behalf of the state. 
  4.2      Subd. 4.  [RULES.] The commissioner shall adopt rules to 
  4.3   implement this section by specifying the criteria used to review 
  4.4   compliance with sections 62J.70 to 62J.73, 62Q.55 to 62Q.58, and 
  4.5   62Q.68 to 62Q.72. 
  4.6      Sec. 5.  [62Q.561] [CONTINUITY OF CARE.] 
  4.7      Subdivision 1.  [CHANGE IN HEALTH PLANS.] (a) A health plan 
  4.8   company must provide coverage for all covered services provided 
  4.9   to a new enrollee by a health care provider who is not a member 
  4.10  of the health plan company's provider network or is not under 
  4.11  contract with the health plan company to provide health services 
  4.12  if, at the time of enrollment, the enrollee is receiving an 
  4.13  ongoing course of treatment from that health care provider and 
  4.14  meets one of the following conditions: 
  4.15     (1) has a life-threatening physical condition, mental 
  4.16  condition, or chronic health care condition; 
  4.17     (2) has a degenerative disease, physical disability, mental 
  4.18  illness, chronic health care condition, or mental retardation or 
  4.19  other related conditions; 
  4.20     (3) has entered the second trimester of pregnancy prior to 
  4.21  the time of enrollment; 
  4.22     (4) is receiving culturally appropriate services and the 
  4.23  health plan company does not have a provider in its preferred 
  4.24  provider network with special expertise in the delivery of these 
  4.25  culturally appropriate services; or 
  4.26     (5) does not speak English and the health plan company does 
  4.27  not have a provider in its preferred provider network that 
  4.28  speaks the language spoken by the enrollee. 
  4.29     (b) This subdivision applies only to group coverage and 
  4.30  continuation and conversion coverage. 
  4.31     Subd. 2.  [CHANGE IN HEALTH CARE PROVIDER.] If a health 
  4.32  care provider leaves a health plan company provider network or 
  4.33  if a health plan company terminates a provider's contract for 
  4.34  reasons other than a violation of the provider's license, the 
  4.35  health plan company must continue to provide coverage for all 
  4.36  covered services provided by the health care provider to an 
  5.1   enrollee of the health plan if, at the time of termination, the 
  5.2   provider is providing services to the enrollee for an ongoing 
  5.3   course of treatment. 
  5.4      Subd. 3.  [LIMITATIONS.] (a) Subdivisions 1 and 2 apply 
  5.5   only if the enrollee's health care provider agrees to: 
  5.6      (1) accept as payment in full the health plan company's 
  5.7   reimbursement rate for out-of-network providers for the same or 
  5.8   similar services; 
  5.9      (2) adhere to the health plan company's preauthorization 
  5.10  requirements; and 
  5.11     (3) provide the health plan company with all necessary 
  5.12  medical information related to the care provided to an enrollee. 
  5.13     (b) An enrollee may receive coverage for all covered 
  5.14  services related to an ongoing course of treatment as described 
  5.15  in subdivision 2 for a period of up to 120 days or through 
  5.16  delivery if an enrollee is pregnant.  This limitation may be 
  5.17  extended by agreement of the health plan company, health care 
  5.18  provider, and enrollee. 
  5.19     (c) Nothing in this section requires a health plan company 
  5.20  to provide coverage for a health care service or treatment that 
  5.21  is not covered under the enrollee's health plan. 
  5.22     Subd. 4.  [DISCLOSURE.] A health plan company must include 
  5.23  a clear statement of the procedures established under this 
  5.24  section as part of any direct-marketing materials and enrollment 
  5.25  packets and evidence of coverage provided to consumers. 
  5.26     Sec. 6.  Minnesota Statutes 1998, section 62Q.58, 
  5.27  subdivision 2, is amended to read: 
  5.28     Subd. 2.  [COORDINATION OF SERVICES.] ~~A primary care~~ 
  5.29  ~~provider or primary care group shall remain responsible for~~ 
  5.30  ~~coordinating the care of an enrollee who has received a standing~~ 
  5.31  ~~referral to a specialist.  The specialist shall not make any~~ 
  5.32  ~~secondary referrals related to primary care services without~~ 
  5.33  ~~prior approval by the primary care provider or primary care~~ 
  5.34  ~~group.  However,~~ An enrollee with a standing referral to a 
  5.35  specialist under subdivision 1 or 4 may request that the health 
  5.36  plan company permit the specialist to become the enrollee's 
  6.1   primary care provider and manage all medical care appropriate to 
  6.2   the enrollee, including primary care services ~~from that~~ 
  6.3   ~~specialist.  The specialist, in agreement with the enrollee and~~ 
  6.4   ~~primary care provider or primary care group, may elect to~~ 
  6.5   ~~provide primary care services to that enrollee according to~~ 
  6.6   ~~procedures established by the health plan company~~, authorization 
  6.7   of tests and services, and all other services covered under the 
  6.8   enrollee benefit plan.  Health plan companies must establish a 
  6.9   procedure for approval of a request for coordination of services 
  6.10  through an appropriate specialist.  
  6.11     Sec. 7.  Minnesota Statutes 1998, section 62Q.58, 
  6.12  subdivision 3, is amended to read: 
  6.13     Subd. 3.  [DISCLOSURE.] ~~Information regarding referral~~ 
  6.14  ~~procedures must be included in member contracts or certificates~~ 
  6.15  ~~of coverage and must be provided to an enrollee or prospective~~ 
  6.16  ~~enrollee by a health plan company upon request~~ A health plan 
  6.17  company must include a clear statement of the procedures 
  6.18  established under subdivisions 1, 2, and 4 as part of any 
  6.19  direct-marketing materials and enrollment packets and evidence 
  6.20  of coverage provided to consumers. 
  6.21     Sec. 8.  Minnesota Statutes 1998, section 62Q.58, is 
  6.22  amended by adding a subdivision to read: 
  6.23     Subd. 4.  [MANDATORY STANDING REFERRAL.] An enrollee who 
  6.24  requests a standing referral to a specialist must be given a 
  6.25  standing referral to an appropriate specialist if the enrollee 
  6.26  meets any of the following conditions: 
  6.27     (1) has a life-threatening physical condition, mental 
  6.28  condition, or chronic health care condition; 
  6.29     (2) has a degenerative disease, physical disability, mental 
  6.30  illness, chronic health care condition, or mental retardation or 
  6.31  other related conditions; or 
  6.32     (3) has entered the second trimester of pregnancy and the 
  6.33  pregnancy has been assessed by the health plan company as high 
  6.34  risk. 
  6.35     Sec. 9.  Minnesota Statutes 1999 Supplement, section 
  6.36  256B.692, subdivision 2, is amended to read: 
  7.1      Subd. 2.  [DUTIES OF THE COMMISSIONER OF HEALTH.] (a) 
  7.2   Notwithstanding chapters 62D and 62N, a county that elects to 
  7.3   purchase medical assistance and general assistance medical care 
  7.4   in return for a fixed sum without regard to the frequency or 
  7.5   extent of services furnished to any particular enrollee is not 
  7.6   required to obtain a certificate of authority under chapter 62D 
  7.7   or 62N.  The county board of commissioners is the governing body 
  7.8   of a county-based purchasing program.  In a multicounty 
  7.9   arrangement, the governing body is a joint powers board 
  7.10  established under section 471.59.  
  7.11     (b) A county that elects to purchase medical assistance and 
  7.12  general assistance medical care services under this section must 
  7.13  satisfy the commissioner of health that the requirements for 
  7.14  assurance of consumer protection, provider protection, and 
  7.15  fiscal solvency of chapter 62D, applicable to health maintenance 
  7.16  organizations, or chapter 62N, applicable to community 
  7.17  integrated service networks, will be met.  
  7.18     (c) A county must also assure the commissioner of health 
  7.19  that the requirements of sections 62J.041; 62J.48; 62J.71 to 
  7.20  62J.73; 62M.01 to 62M.16; all applicable provisions of chapter 
  7.21  62Q, including sections 62Q.07; 62Q.075; 62Q.1055; 62Q.106; 
  7.22  62Q.12; 62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23, paragraph (c); 
  7.23  62Q.43; 62Q.47; 62Q.50; 62Q.52 to ~~62Q.56~~ 62Q.561; 62Q.58; 
  7.24  62Q.64; 62Q.68 to 62Q.72; and 72A.201 will be met.  
  7.25     (d) All enforcement and rulemaking powers available under 
  7.26  chapters 62D, 62J, 62M, 62N, and 62Q are hereby granted to the 
  7.27  commissioner of health with respect to counties that purchase 
  7.28  medical assistance and general assistance medical care services 
  7.29  under this section.  
  7.30     (e) The commissioner, in consultation with county 
  7.31  government, shall develop administrative and financial reporting 
  7.32  requirements for county-based purchasing programs relating to 
  7.33  sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 
  7.34  62N.31, and other sections as necessary, that are specific to 
  7.35  county administrative, accounting, and reporting systems and 
  7.36  consistent with other statutory requirements of counties.  
  8.1      Sec. 10.  [REPEALER.] 
  8.2      Minnesota Statutes 1998, section 62Q.56, is repealed. 
  8.3      Sec. 11.  [EFFECTIVE DATE.] 
  8.4      Sections 3 to 10 are effective January 1, 2001.