1.1                          A bill for an act
  1.2             relating to health; requiring managed care plans to 
  1.3             provide certain enrollees with expanded geographic 
  1.4             access to primary care physician services; proposing 
  1.5             coding 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.  [62Q.43] [PRIMARY CARE PHYSICIAN SERVICES.] 
  1.8      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  1.9   section, the following definitions apply: 
  1.10     (a) "Eligible enrollee" means an individual covered under a 
  1.11  managed care plan who is:  (1) a full-time college student who 
  1.12  attends a college or university that is located more than 30 
  1.13  miles from the enrollee's principal residence; or (2) employed 
  1.14  full-time at a work site that is located more than 30 miles from 
  1.15  the enrollee's principal residence. 
  1.16     (b) "Managed care organization" means:  (1) a health 
  1.17  maintenance organization operating under chapter 62D; (2) a 
  1.18  community integrated service network as defined under section 
  1.19  62N.02, subdivision 4a; (3) an integrated service network as 
  1.20  defined under section 62N.02, subdivision 8; or (4) an insurance 
  1.21  company licensed under chapter 60A, nonprofit health service 
  1.22  plan corporation operating under chapter 62C, fraternal benefit 
  1.23  society operating under chapter 64B, or any other health plan 
  1.24  company as defined under section 62Q.01, subdivision 4, to the 
  1.25  extent that it covers health care services delivered through a 
  2.1   preferred provider organization or a network of selected 
  2.2   providers. 
  2.3      (c) "Managed care plan" means health coverage offered, 
  2.4   issued, or renewed by a managed care organization. 
  2.5      (d) "Primary care physician services" means services 
  2.6   provided by a licensed physician who:  (1) is in general 
  2.7   practice; (2) has special education, training, or experience in 
  2.8   family practice, pediatrics, internal medicine, or obstetrics 
  2.9   and gynecology; or (3) is board certified or board-eligible and 
  2.10  working toward certification in a board approved by the American 
  2.11  Board of Medical Specialists or the American Board of 
  2.12  Osteopathy, in family practice, pediatrics, internal medicine, 
  2.13  or obstetrics and gynecology. 
  2.14     Subd. 2.  [GEOGRAPHIC ACCESS OPTION.] (a) Managed care 
  2.15  plans must allow eligible enrollees the option of receiving 
  2.16  primary care physician services in two geographic locations.  A 
  2.17  managed care plan must not charge or assess eligible enrollees 
  2.18  choosing this option higher premium payments or cost-sharing 
  2.19  requirements than would otherwise apply to enrollees who are not 
  2.20  eligible for this option.  If the managed care plan requires 
  2.21  enrollees to designate a primary care physician from whom the 
  2.22  enrollee must receive a majority of or all primary care 
  2.23  physician services, the plan must allow an eligible enrollee to 
  2.24  designate a primary care physician for each geographic 
  2.25  location.  This paragraph applies only if one of the geographic 
  2.26  locations selected for primary care physician service is:  (1) 
  2.27  closer to the eligible enrollee's college, university, or work 
  2.28  site than it is to the eligible enrollee's principal residence; 
  2.29  or (2) closer to the eligible enrollee's principal residence 
  2.30  than it is to the eligible enrollee's college, university, or 
  2.31  work site. 
  2.32     (b) A managed care plan may require an eligible enrollee to 
  2.33  select a primary care physician who is a member of the plan's 
  2.34  provider network, only if the network includes a physician who 
  2.35  is located within 30 miles of the enrollee's principal 
  2.36  residence, college, university, or work site.  If the principal 
  3.1   residence, college, university, or work site of an eligible 
  3.2   enrollee is not located within 30 miles of a primary care 
  3.3   physician who is a member of the managed care plan's provider 
  3.4   network, the managed care plan must contract or agree to pay for 
  3.5   the provision of primary care physician services from a 
  3.6   non-network physician, without additional charge to the eligible 
  3.7   enrollee. 
  3.8      (c) Paragraphs (a) and (b) do not apply if:  (1) there is 
  3.9   no primary care physician practicing within 30 miles of an 
  3.10  eligible enrollee's principal residence, college, university, or 
  3.11  work site; or (2) the managed care organization is not 
  3.12  successful in contracting or arranging for the provision of 
  3.13  primary care physician services at a reimbursement rate equal to 
  3.14  the prevailing rate for the geographic area.