1.1                          A bill for an act 
  1.2             relating to insurance; making certain changes 
  1.3             involving the joint underwriting association's 
  1.4             procedures; providing continuation coverage for 
  1.5             certain life insurance; providing for health care 
  1.6             administrative simplification; amending Minnesota 
  1.7             Statutes 2000, sections 61A.092, subdivision 6; 
  1.8             62F.04, by adding a subdivision; 62J.51, subdivision 
  1.9             19; 62J.535, subdivision 2, by adding subdivisions; 
  1.10            62J.581; repealing Minnesota Statutes 2000, sections 
  1.11            62F.04, subdivision 1a; 62J.535, subdivision 1. 
  1.12  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.13                             ARTICLE 1 
  1.14                   JOINT UNDERWRITING ASSOCIATION
  1.15     Section 1.  Minnesota Statutes 2000, section 62F.04, is 
  1.16  amended by adding a subdivision to read: 
  1.17     Subd. 3.  [AVOIDANCE OF GRAVE RISK.] Because the activities 
  1.18  of certain persons or entities present a risk that is so great, 
  1.19  the association shall not offer insurance coverage to any person 
  1.20  or entity the board of directors of the association determines 
  1.21  is outside the intended scope and purpose of the association 
  1.22  because of the gravity of the risk of offering insurance 
  1.23  coverage. 
  1.24     Sec. 2.  [REPEALER.] 
  1.25     Minnesota Statutes 2000, section 62F.04, subdivision 1a, is 
  1.26  repealed. 
  1.27     Sec. 3.  [EFFECTIVE DATE.] 
  1.28     Sections 1 and 2 are effective the day following final 
  2.1   enactment. 
  2.2                              ARTICLE 2 
  2.3                       OTHER INSURANCE CHANGES 
  2.4      Section 1.  Minnesota Statutes 2000, section 61A.092, 
  2.5   subdivision 6, is amended to read: 
  2.6      Subd. 6.  [APPLICATION.] This section applies to a policy, 
  2.7   certificate of insurance, or similar evidence of coverage issued 
  2.8   to a Minnesota resident or issued to provide coverage to a 
  2.9   Minnesota resident.  This section does not apply to:  (1) a 
  2.10  certificate of insurance or similar evidence of coverage that 
  2.11  meets the conditions of section 61A.093, subdivision 2; or (2) a 
  2.12  group life insurance policy that contains a provision permitting 
  2.13  the certificate holder, upon termination or layoff from 
  2.14  employment, to retain the coverage provided under the group 
  2.15  policy by paying premiums directly to the insurer, provided that 
  2.16  the employer shall give the employee notice of the employee's 
  2.17  and each related certificate holder's right to continue the 
  2.18  insurance by paying premiums directly to the insurer.  The 
  2.19  insurer may reserve the right to increase premium rates after 
  2.20  the first 18 months of continued coverage provided for under 
  2.21  clause (2).  A related certificate holder is an insured spouse 
  2.22  or dependent child of the employee.  Upon termination of this 
  2.23  group policy or at the option of the insured who has continued 
  2.24  coverage under clause (2), each covered employee, spouse, and 
  2.25  dependent child is entitled to have issued to them a life 
  2.26  conversion policy as prescribed in section 61A.09, subdivision 
  2.27  1, paragraph (h). 
  2.28     Sec. 2.  Minnesota Statutes 2000, section 62J.51, 
  2.29  subdivision 19, is amended to read: 
  2.30     Subd. 19.  [UNIFORM DENTAL BILLING FORM.] "Uniform dental 
  2.31  billing form" means the ~~1990~~ most current version uniform dental 
  2.32  claim form developed by the American Dental Association. 
  2.33     Sec. 3.  Minnesota Statutes 2000, section 62J.535, is 
  2.34  amended by adding a subdivision to read: 
  2.35     Subd. 1a.  [ELECTRONIC CLAIM TRANSACTIONS.] Group 
  2.36  purchasers, including government programs, not defined as 
  3.1   covered entities under United States Code, title 42, sections 
  3.2   1320d to 1320d-8, as amended from time to time, and the rules 
  3.3   promulgated under those sections, that voluntarily agree with 
  3.4   providers to accept electronic claim transactions, must accept 
  3.5   them in the ANSI X12N 837 standard electronic format as 
  3.6   established by federal law.  Nothing in this section requires 
  3.7   acceptance of electronic claim transactions by entities not 
  3.8   covered under United States Code, title 42, sections 1320d to 
  3.9   1320d-8, as amended from time to time, and the rules promulgated 
  3.10  under those sections.  Notwithstanding the above, nothing in 
  3.11  this section or other state law prohibits group purchasers not 
  3.12  defined as covered entities under United States Code, title 42, 
  3.13  sections 1320d to 1320d-8, as amended from time to time, and the 
  3.14  rules promulgated under those sections, from requiring, as 
  3.15  authorized by Minnesota law or rule, additional information 
  3.16  associated with a claim submitted by a provider. 
  3.17     Sec. 4.  Minnesota Statutes 2000, section 62J.535, is 
  3.18  amended by adding a subdivision to read: 
  3.19     Subd. 1b.  [PAPER CLAIM TRANSACTIONS.] All group purchasers 
  3.20  that accept paper claim transactions must accept, and health 
  3.21  care providers submitting paper claim transactions must submit, 
  3.22  such transactions with use of the applicable medical and 
  3.23  nonmedical data code sets specified in the federal electronic 
  3.24  claim transaction standards adopted under United States Code, 
  3.25  title 42, sections 1320d to 1320d-8, as amended from time to 
  3.26  time, and the rules promulgated under those sections.  The paper 
  3.27  claim transaction must also be conducted using the uniform 
  3.28  billing forms as specified in section 62J.52 and the identifiers 
  3.29  specified in section 62J.54, on and after the compliance date 
  3.30  required by law.  Notwithstanding the above, nothing in this 
  3.31  section or other state law prohibits group purchasers not 
  3.32  defined as covered entities under United States Code, title 42, 
  3.33  sections 1320d to 1320d-8, as amended from time to time, and the 
  3.34  rules promulgated under those sections, from requiring, as 
  3.35  authorized by Minnesota law or rule, additional information 
  3.36  associated with a claim submitted by a provider. 
  4.1      Sec. 5.  Minnesota Statutes 2000, section 62J.535, 
  4.2   subdivision 2, is amended to read: 
  4.3      Subd. 2.  [COMPLIANCE.] ~~(a)~~ Subdivision 1a is effective 
  4.4   concurrent with the date of required compliance for covered 
  4.5   entities established under United States Code, title 42, 
  4.6   sections 1320d to 1320d-8, as amended from time to time~~, for~~ 
  4.7   ~~uniform electronic billing standards, all health care providers~~ 
  4.8   ~~must conform to the uniform billing standards developed under~~ 
  4.9   ~~subdivision 1~~. 
  4.10     ~~(b) Notwithstanding paragraph (a), the requirements for the~~ 
  4.11  ~~uniform remittance advice report shall be effective 12 months~~ 
  4.12  ~~after the date of the required compliance of the standards for~~ 
  4.13  ~~the electronic remittance advice transaction are effective under~~ 
  4.14  ~~United States Code, title 42, sections 1320d to 1320d-8, as~~ 
  4.15  ~~amended from time to time.~~ 
  4.16     Sec. 6.  Minnesota Statutes 2000, section 62J.581, is 
  4.17  amended to read: 
  4.18     62J.581 [STANDARDS FOR MINNESOTA UNIFORM HEALTH CARE 
  4.19  REIMBURSEMENT DOCUMENTS.] 
  4.20     Subdivision 1.  [MINNESOTA UNIFORM REMITTANCE ADVICE 
  4.21  REPORT.] All group purchasers ~~and payers~~ shall provide a uniform 
  4.22  remittance advice report to health care providers when a claim 
  4.23  is adjudicated.  The uniform remittance advice report shall 
  4.24  comply with the standards prescribed in this section.  
  4.25  Notwithstanding the above, this section does not apply to group 
  4.26  purchasers not included as covered entities under United States 
  4.27  Code, title 42, sections 1320d to 1320d-8, as amended from time 
  4.28  to time, and the rules promulgated under those sections. 
  4.29     Subd. 2.  [MINNESOTA UNIFORM EXPLANATION OF BENEFITS 
  4.30  DOCUMENT.] All group purchasers ~~and payers~~ shall provide a 
  4.31  uniform explanation of benefits document to health care patients 
  4.32  when ~~a claim is adjudicated~~ an explanation of benefits document 
  4.33  is provided as otherwise required or permitted by law.  The 
  4.34  uniform explanation of benefits document shall comply with the 
  4.35  standards prescribed in this section.  Notwithstanding the 
  4.36  above, this section does not apply to group purchasers not 
  5.1   included as covered entities under United States Code, title 42, 
  5.2   sections 1320d to 1320d-8, as amended from time to time, and the 
  5.3   rules promulgated under those sections. 
  5.4      Subd. 3.  [SCOPE.] For purposes of sections 62J.50 to 
  5.5   62J.61, the uniform remittance advice report and the uniform 
  5.6   explanation of benefits document format specified in subdivision 
  5.7   4 shall apply to all health care services delivered by a health 
  5.8   care provider or health care provider organization in Minnesota, 
  5.9   regardless of the location of the payer.  Health care services 
  5.10  not paid on an individual claims basis, such as capitated 
  5.11  payments, are not included in this section.  A health plan 
  5.12  company is excluded from the requirements in subdivisions 1 and 
  5.13  2 if they comply with section 62A.01, subdivisions 2 and 3. 
  5.14     Subd. 4.  [SPECIFICATIONS.] The uniform remittance advice 
  5.15  report and the uniform explanation of benefits document shall be 
  5.16  provided by use of a paper document conforming to the 
  5.17  specifications in this section or by use of the ANSI X12N 835 
  5.18  standard electronic format as established under United States 
  5.19  Code, title 42, sections 1320d to 1320d-8, and as amended from 
  5.20  time to time for the remittance advice.  The commissioner, after 
  5.21  consulting with the administrative uniformity committee, shall 
  5.22  specify the data elements and definitions for the uniform 
  5.23  remittance advice report and the uniform explanation of benefits 
  5.24  document.  The commissioner and the administrative uniformity 
  5.25  committee must consult with the Minnesota Dental Association and 
  5.26  Delta Dental Plan of Minnesota before requiring under this 
  5.27  section the use of a paper document for the uniform explanation 
  5.28  of benefits document or the uniform remittance advice report for 
  5.29  dental care services.  
  5.30     Subd. 5.  [EFFECTIVE DATE.] The requirements in 
  5.31  subdivisions 1 and 2 are effective ~~12 months after the date of~~ 
  5.32  ~~required compliance with the standards for the electronic~~ 
  5.33  ~~remittance advice transaction under United States Code, title~~ 
  5.34  ~~42, sections 1320d to 1320d-8, and as amended from time to~~ 
  5.35  ~~time~~ October 16, 2004.  The requirements in subdivisions 1 and 2 
  5.36  apply regardless of when the health care service was provided to 
  6.1   the patient. 
  6.2      Sec. 7.  [REVISOR INSTRUCTION.] 
  6.3      The revisor of statutes is instructed to amend the headnote 
  6.4   of Minnesota Statutes, section 62J.535, to read "Uniform Billing 
  6.5   Requirements for Claim Transactions." 
  6.6      Sec. 8.  [REPEALER.] 
  6.7      Minnesota Statutes 2000, section 62J.535, subdivision 1, is 
  6.8   repealed. 
  6.9      Sec. 9.  [EFFECTIVE DATE.] 
  6.10     Section 1 is effective the day following final enactment.