1.1                          A bill for an act
  1.2             relating to insurance; providing a uniform minimum 
  1.3             definition of medically necessary care for mental 
  1.4             health coverage in health plans; proposing coding for 
  1.5             new law in Minnesota Statutes, chapter 62Q. 
  1.6   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.7      Section 1.  [62Q.60] [MENTAL HEALTH COVERAGE; MINIMUM 
  1.8   STANDARDS FOR MEDICALLY NECESSARY CARE.] 
  1.9      Subdivision 1.  [REQUIREMENT.] No health plan that covers 
  1.10  mental health services may be offered, sold, issued, or renewed 
  1.11  in this state that requires mental health services to satisfy a 
  1.12  definition of "medically necessary care," "medical necessity," 
  1.13  or similar term that is more restrictive with respect to mental 
  1.14  health than the definition provided in subdivision 2. 
  1.15     Subd. 2.  [MINIMUM DEFINITION.] "Medically necessary care" 
  1.16  means health care services appropriate, in terms of type, 
  1.17  frequency, level, setting, and duration, to the enrollee's 
  1.18  diagnosis or condition, and diagnostic testing and preventive 
  1.19  services.  Medically necessary care must be consistent with 
  1.20  generally accepted practice parameters as determined by health 
  1.21  care providers in the same or similar general specialty as 
  1.22  typically manages the condition, procedure, or treatment at 
  1.23  issue and must: 
  1.24     (1) help restore or maintain the enrollee's health; 
  1.25     (2) prevent deterioration of the enrollee's condition; or 
  2.1      (3) prevent the reasonably likely onset of a health problem 
  2.2   or detect an incipient problem. 
  2.3      Subd. 3.  [HEALTH PLAN; DEFINITION.] For purposes of this 
  2.4   section, "health plan" has the meaning given in section 62Q.01, 
  2.5   subdivision 3, but includes the coverages listed in section 
  2.6   62A.011, subdivision 3, clauses (7) and (10). 
  2.7      Sec. 2.  [EFFECTIVE DATE.] 
  2.8      Section 1 is effective January 1, 1998, and applies to 
  2.9   health plans issued or renewed on or after that date.