Health maintenance organizations provisions modification

A bill for an act

relating to health; making changes to provisions covering health maintenance

organizations; amending Minnesota Statutes 2024, sections 62D.02, subdivision

7, by adding a subdivision; 62D.08, subdivisions 5, 6; 62D.09, subdivisions 1, 5;

62D.124, subdivision 6; repealing Minnesota Statutes 2024, sections 62D.08,

subdivision 7; 62D.181.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62D.02, subdivision 7, is amended to read:

Subd. 7.

Comprehensive health maintenance services.

"Comprehensive health

maintenance services" means a set of comprehensive health services which the enrollees

might reasonably require to be maintained in good health including as a minimum, but not

limited to, emergency care, emergency ground ambulance transportation services, inpatient

hospital and physician care, outpatient health services and preventive
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health
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items and
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services.

Sec. 2.

Minnesota Statutes 2024, section 62D.02, is amended by adding a subdivision to

read:

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Subd. 18.

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Service area.

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"Service area" means the geographic locations in which the

health maintenance organization is approved by the commissioner to sell its health

maintenance organization products. Geographic locations shall be identified according to

recognized political subdivisions such as cities, counties, and townships.

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Sec. 3.

Minnesota Statutes 2024, section 62D.08, subdivision 5, is amended to read:

Subd. 5.

Changes in participating entities; penalty.

Any cancellation or discontinuance

of any contract or agreement listed in section
62D.03, subdivision 4
, clause (e), or listed

subsequently in accordance with this subdivision, shall be reported to the commissioner

120 days before the effective date. When the health maintenance organization terminates a
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provider
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participating entity
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for cause, death, disability, or loss of license, the health

maintenance organization must notify the commissioner within ten working days of the

date the health maintenance organization sends out or receives the notice of cancellation,

discontinuance, or termination. Any health maintenance organization which fails to notify

the commissioner within the time periods prescribed in this subdivision shall be subject to

the levy of a fine up to $200 per contract for each day the notice is past due, accruing up to

the date the organization notifies the commissioner of the cancellation or discontinuance.

Any fine levied under this subdivision is subject to the contested case and judicial review

provisions of chapter 14. The levy of a fine does not preclude the commissioner from using

other penalties described in sections
62D.15
to
62D.17
.

Sec. 4.

Minnesota Statutes 2024, section 62D.08, subdivision 6, is amended to read:

Subd. 6.

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Quarterly
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financial statements.

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(a)
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A health maintenance organization shall

submit to the commissioner unaudited financial statements of the organization for the first

three quarters of the year on forms prescribed by the commissioner. The statements are due

30 days after the end of the quarter and shall be maintained as nonpublic data, as defined

by section
13.02, subdivision 9
. Unaudited financial statements for the fourth quarter shall

be submitted at the request of the commissioner.

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(b) Every health maintenance organization must directly allocate administrative expenses

to specific lines of business or products when such information is available. Remaining

expenses that cannot be directly allocated must be allocated based on other methods, as

recommended by the Advisory Group on Administrative Expenses. Health maintenance

organizations must submit this information, including administrative expenses for dental

services, using the reporting template provided by the commissioner of health.

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(c) Every health maintenance organization must allocate investment income based on

cumulative net income over time by business line or product and must submit this

information, including investment income for dental services, using the reporting template

provided by the commissioner of health.

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Sec. 5.

Minnesota Statutes 2024, section 62D.09, subdivision 1, is amended to read:

Subdivision 1.

Marketing requirements.

(a) Any written marketing materials which

may be directed toward potential enrollees and which include a detailed description of

benefits provided by the health maintenance organization shall include a statement of enrollee

information and rights as described in section
62D.07, subdivision 3
, clauses (2) and (3).

Prior to any oral marketing presentation, the agent marketing the plan must inform the

potential enrollees that any complaints concerning the material presented should be directed

to the health maintenance organization, the commissioner of health, or, if applicable, the

employer.

(b) Detailed marketing materials must affirmatively disclose all exclusions and limitations

in the organization's services or kinds of services offered to the contracting party, including

but not limited to the following types of exclusions and limitations:

(1) health care services not provided;

(2) health care services requiring co-payments or deductibles paid by enrollees;

(3) the fact that access to health care services does not guarantee access to a particular
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provider or
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provider type; and

(4) health care services that are or may be provided only by referral of a physician,

advanced practice registered nurse, or physician assistant.

(c) No marketing materials may lead consumers to believe that all health care needs will

be covered. All marketing materials must alert consumers to possible uncovered expenses

with the following language in bold print: "THIS HEALTH CARE PLAN MAY NOT

COVER ALL YOUR HEALTH CARE EXPENSES; READ YOUR CONTRACT

CAREFULLY TO DETERMINE WHICH EXPENSES ARE COVERED." Immediately

following the disclosure required under paragraph (b), clause (3), consumers must be given

a telephone number to use to contact the health maintenance organization for specific

information about access to provider types.

(d) The disclosures required in paragraphs (b) and (c) are not required on billboards or

image, and name identification advertisement.

Sec. 6.

Minnesota Statutes 2024, section 62D.09, subdivision 5, is amended to read:

Subd. 5.

Participating providers.

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(a)
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Health maintenance organizations shall
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provide

enrollees with a list of the names and locations of participating providers to whom enrollees

have direct access without referral no later than the effective date of enrollment or date the

evidence of coverage is issued and upon request
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publish an up-to-date, accurate, and complete

provider directory, including information on which providers are accepting new patients,

the provider's location, contact information, specialty, medical group, and any institutional

affiliations, in a manner that is easily accessible to enrollees and potential enrollees
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. Health

maintenance organizations need not provide the names of their employed providers.

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(b) Upon request, a health maintenance organization shall provide a hard copy of the

provider directory to enrollees or potential enrollees.

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Sec. 7.

Minnesota Statutes 2024, section 62D.124, subdivision 6, is amended to read:

Subd. 6.

Provider network notifications.

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(a)
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A health maintenance organization must

provide on the organization's website the provider network for each product offered by the

organization, and must update the organization's website at least once a month with any

changes to the organization's provider network, including provider changes from in-network

status to out-of-network status. A health maintenance organization must also provide on

the organization's website, for each product offered by the organization, a list of the current

waivers of the requirements in subdivision 1 or 2, in a format that is easily accessed and

searchable by enrollees and prospective enrollees.

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(b) Upon notification from an enrollee, a health carrier must reprocess any claim for

services provided by a provider whose status has changed from in-network to out-of-network

as an in-network claim if the service was provided after the network change went into effect

but before the change was posted as required under paragraph (a), unless the health carrier

notified the enrollee of the network change prior to the service being provided. This paragraph

does not apply if the health carrier is able to verify that the health carrier's website displayed

the correct provider network status on the health carrier's website at the time the service

was provided.

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Sec. 8.
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REVISOR INSTRUCTION.
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The revisor of statutes shall renumber the section of Minnesota Statutes listed in column

A with the number listed in column B. The revisor shall also make necessary cross reference

changes consistent with the renumbering.

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Column A

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Column B

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62Q.075

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62D.081

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Sec. 9.
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REPEALER.
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Minnesota Statutes 2024, sections 62D.08, subdivision 7; and 62D.181,

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are repealed.

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APPENDIX

Repealed Minnesota Statutes: 26-06196

62D.08 ANNUAL REPORT.

Subd. 7.

Consistent administrative expenses and investment income reporting.

(a) Every health maintenance organization must directly allocate administrative expenses to specific lines of business or products when such information is available. Remaining expenses that cannot be directly allocated must be allocated based on other methods, as recommended by the Advisory Group on Administrative Expenses. Health maintenance organizations must submit this information, including administrative expenses for dental services, using the reporting template provided by the commissioner of health.

(b) Every health maintenance organization must allocate investment income based on cumulative net income over time by business line or product and must submit this information, including investment income for dental services, using the reporting template provided by the commissioner of health.

62D.181 INSOLVENCY; MCHA ALTERNATIVE COVERAGE.

Subdivision 1.

Definition.

"Association" means the Minnesota Comprehensive Health Association created in section
62E.10
.

Subd. 2.

Eligible individuals.

An individual is eligible for alternative coverage under this section if:

(1) the individual had individual health coverage through a health maintenance organization or community integrated service network, the coverage is no longer available due to the insolvency of the health maintenance organization or community integrated service network, and the individual has not obtained alternative coverage; or

(2) the individual had group health coverage through a health maintenance organization or community integrated service network, the coverage is no longer available due to the insolvency of the health maintenance organization or community integrated service network, and the individual has not obtained alternative coverage.

Subd. 3.

Application and issuance.

If a health maintenance organization or community integrated service network will be liquidated, individuals eligible for alternative coverage under subdivision 2 may apply to the association to obtain alternative coverage. Upon receiving an application and evidence that the applicant was enrolled in the health maintenance organization or community integrated service network at the time of an order for liquidation, the association shall issue policies to eligible individuals, without the limitation on preexisting conditions described in section
62E.14, subdivision 3
.

Subd. 4.

Coverage.

Alternative coverage issued under this section must be at least a number two qualified plan, as described in section
62E.06, subdivision 2
, or for individuals over age 65, a basic Medicare supplement plan, as described in section
62A.316
.

Subd. 5.

Premium.

The premium for alternative coverage issued under this section must not exceed 80 percent of the premium for the comparable coverage offered by the association.

Subd. 6.

Duration.

The duration of alternative coverage issued under this section is:

(1) for individuals eligible under subdivision 2, clause (1), 90 days; and

(2) for individuals eligible under subdivision 2, clause (2), 90 days or the length of time remaining in the group contract with the insolvent health maintenance organization or community integrated service network, whichever is greater.

Subd. 7.

Replacement coverage; limitations.

The association is not obligated to offer replacement coverage under this chapter at the end of the periods specified in subdivision 6. Any continuation obligation arising under this chapter or chapter 62A will cease at the end of the periods specified in subdivision 6.

Subd. 8.

Claims expenses exceeding premiums.

Claims expenses resulting from the operation of this section which exceed premiums received shall be borne by contributing members of the association in accordance with section
62E.11, subdivision 5
.

Subd. 9.

Coordination of policies.

If an insolvent health maintenance organization or community integrated service network has insolvency insurance coverage at the time of an order for liquidation, the association may coordinate the benefits of the policy issued under this section with those of the insolvency insurance policy available to the enrollees. The premium level for the combined association policy and the insolvency insurance policy may not exceed those described in subdivision 5.