1.1                          A bill for an act 
  1.2             relating to health; providing for patient protection; 
  1.3             amending Minnesota Statutes 1997 Supplement, sections 
  1.4             62J.72, subdivision 1; and 62Q.30; proposing coding 
  1.5             for new law in Minnesota Statutes, chapter 62Q. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.8   62J.72, subdivision 1, is amended to read: 
  1.9      Subdivision 1.  [WRITTEN DISCLOSURE.] (a) A health plan 
  1.10  company, as defined under section 62J.70, subdivision 3, a 
  1.11  health care network cooperative as defined under section 62R.04, 
  1.12  subdivision 3, and a health care provider as defined under 
  1.13  section 62J.70, subdivision 2, shall, during open enrollment, 
  1.14  upon enrollment, and annually thereafter, provide enrollees with 
  1.15  a description of the general nature of the reimbursement 
  1.16  methodologies used by the health plan company, health insurer, 
  1.17  or health coverage plan to pay providers.  This description may 
  1.18  be incorporated into the member handbook, subscriber contract, 
  1.19  certificate of coverage, or other written enrollee 
  1.20  communication.  The general reimbursement methodology shall be 
  1.21  made available to employers at the time of open enrollment.  
  1.22     (b) Health plan companies and providers must, upon request, 
  1.23  provide an enrollee with specific information regarding the 
  1.24  reimbursement methodology, including, but not limited to, the 
  1.25  following information:  
  2.1      (1) a concise written description of the provider payment 
  2.2   plan, including any incentive plan applicable to the enrollee; 
  2.3      (2) a written description of any incentive to the provider 
  2.4   relating to the provision of health care services to enrollees, 
  2.5   including any compensation arrangement that is dependent on the 
  2.6   amount of health coverage or health care services provided to 
  2.7   the enrollee, or the number of referrals to or utilization of 
  2.8   specialists; and 
  2.9      (3) a written description of any incentive plan that 
  2.10  involves the transfer of financial risk to the health care 
  2.11  provider; and 
  2.12     (4) a written report detailing revenues received from drug 
  2.13  company rebates and the amounts of the rebates allocated to 
  2.14  specific line items in the budget of the health plan. 
  2.15     (c) The disclosure statement describing the general nature 
  2.16  of the reimbursement methodologies must comply with the 
  2.17  Readability of Insurance Policies Act in chapter 72C.  
  2.18  Notwithstanding any other law to the contrary, the disclosure 
  2.19  statement may voluntarily be filed with the commissioner for 
  2.20  approval. 
  2.21     (d) A disclosure statement that has voluntarily been filed 
  2.22  with the commissioner for approval under chapter 72C or 
  2.23  voluntarily filed with the commissioner for approval for 
  2.24  purposes other than pursuant to chapter 72C is deemed approved 
  2.25  30 days after the date of filing, unless approved or disapproved 
  2.26  by the commissioner on or before the end of that 30-day period. 
  2.27     (e) The disclosure statement describing the general nature 
  2.28  of the reimbursement methodologies must be provided upon request 
  2.29  in English, Spanish, Vietnamese, and Hmong.  In addition, 
  2.30  reasonable efforts must be made to provide information contained 
  2.31  in the disclosure statement to other non-English-speaking 
  2.32  enrollees. 
  2.33     (f) Health plan companies and providers may enter into 
  2.34  agreements to determine how to respond to enrollee requests 
  2.35  received by either the provider or the health plan company.  
  2.36  This subdivision does not require disclosure of specific amounts 
  3.1   paid to a provider, provider fee schedules, provider salaries, 
  3.2   or other proprietary information of a specific health plan 
  3.3   company or health insurer or health coverage plan or provider. 
  3.4      Sec. 2.  Minnesota Statutes 1997 Supplement, section 
  3.5   62Q.30, is amended to read: 
  3.6      62Q.30 [EXPEDITED FACT FINDING AND DISPUTE RESOLUTION 
  3.7   PROCESS INDEPENDENT APPEALS BOARD.] 
  3.8      Subdivision 1.  [CREATION; MEMBERS.] (a) The commissioner 
  3.9   shall establish an expedited fact finding and dispute resolution 
  3.10  process independent appeals board to assist enrollees of health 
  3.11  plan companies with contested treatment, coverage, and service 
  3.12  issues to be in effect July 1, 1998.  
  3.13     (b) The appeals board shall consist of ten members, five of 
  3.14  whom shall represent the health care profession and five of whom 
  3.15  shall represent consumers.  Health care professionals shall be 
  3.16  nominated by their respective professional groups.  Interested 
  3.17  consumer groups shall submit nominations to the commissioner for 
  3.18  the consumer positions.  Total representation shall be one from 
  3.19  each of the eight congressional districts and two appointed at 
  3.20  large.  All age groups shall be represented in final 
  3.21  appointments.  Terms shall be a minimum of three years. 
  3.22     Subd. 2.  [RECOMMENDATIONS.] If the disputed issue relates 
  3.23  to whether a service is appropriate and necessary, 
  3.24  the commissioner appeals board shall issue an order make 
  3.25  recommendations only after consulting with appropriate experts 
  3.26  knowledgeable, trained, and practicing in the area in dispute, 
  3.27  reviewing pertinent literature the enrollee, the enrollee's 
  3.28  physician, and other experts practicing in the area in dispute, 
  3.29  and considering the availability of satisfactory 
  3.30  alternatives.  In no case shall the burden of proof rest upon 
  3.31  the enrollee or the attending physician.  The enrollee may elect 
  3.32  to have the recommendation of the appeals board reviewed by a 
  3.33  biomedical ethicist. 
  3.34     Subd. 3.  [COMMISSIONER'S ORDER.] The commissioner shall 
  3.35  consider the recommendations of the appeals board.  The 
  3.36  commissioner shall take steps including but not limited to 
  4.1   fining, suspending, or revoking the license of a health plan 
  4.2   company that is the subject of repeated orders by the 
  4.3   commissioner that suggests a pattern of inappropriate 
  4.4   underutilization.  An enrollee may appeal the final decision of 
  4.5   the commissioner as provided under chapter 14. 
  4.6      Sec. 3.  [62Q.31] [MEDICATION APPEAL.] 
  4.7      If an enrollee's prescribed medication is not on a health 
  4.8   plan's preapproved formulary, the enrollee or the enrollee's 
  4.9   physician may appeal according to sections 62Q.105 and 62Q.30.