(a) As a condition of doing business in Minnesota or providing coverage to residents of Minnesota covered by this section, each health insurer shall comply with the requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171, including any federal regulations adopted under that act, to the extent that it imposes a requirement that applies in this state and that is not also required by the laws of this state. This section does not require compliance with any provision of the federal act prior to the effective date provided for that provision in the federal act. The commissioner shall enforce this section.
For the purpose of this section, "health insurer" includes self-insured plans, group health plans (as defined in section 607(1) of the Employee Retirement Income Security Act of 1974), service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are by contract legally responsible to pay a claim for a health-care item or service for an individual receiving benefits under paragraph (b).
(b) No plan offered by a health insurer issued or renewed to provide coverage to a Minnesota resident shall contain any provision denying or reducing benefits because services are rendered to a person who is eligible for or receiving medical benefits pursuant to title XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256 or 256B; or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331, subdivision 2; 260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer providing benefits under plans covered by this section shall use eligibility for medical programs named in this section as an underwriting guideline or reason for nonacceptance of the risk.
(c) If payment for covered expenses has been made under state medical programs for health care items or services provided to an individual, and a third party has a legal liability to make payments, the rights of payment and appeal of an adverse coverage decision for the individual, or in the case of a child their responsible relative or caretaker, will be subrogated to the state agency. The state agency may assert its rights under this section within three years of the date the service was rendered. For purposes of this section, "state agency" includes prepaid health plans under contract with the commissioner according to sections 256B.69 and 256L.12; children's mental health collaboratives under section 245.493; demonstration projects for persons with disabilities under section 256B.77; nursing homes under the alternative payment demonstration project under section 256B.434; and county-based purchasing entities under section 256B.692.
(d) Notwithstanding any law to the contrary, when a person covered by a plan offered by a health insurer receives medical benefits according to any statute listed in this section, payment for covered services or notice of denial for services billed by the provider must be issued directly to the provider. If a person was receiving medical benefits through the Department of Human Services at the time a service was provided, the provider must indicate this benefit coverage on any claim forms submitted by the provider to the health insurer for those services. If the commissioner of human services notifies the health insurer that the commissioner has made payments to the provider, payment for benefits or notices of denials issued by the health insurer must be issued directly to the commissioner. Submission by the department to the health insurer of the claim on a Department of Human Services claim form is proper notice and shall be considered proof of payment of the claim to the provider and supersedes any contract requirements of the health insurer relating to the form of submission. Liability to the insured for coverage is satisfied to the extent that payments for those benefits are made by the health insurer to the provider or the commissioner as required by this section.
(e) When a state agency has acquired the rights of an individual eligible for medical programs named in this section and has health benefits coverage through a health insurer, the health insurer shall not impose requirements that are different from requirements applicable to an agent or assignee of any other individual covered.
(f) A health insurer must process a clean claim made by a state agency for covered expenses paid under state medical programs within 90 business days of the claim's submission. A health insurer must process all other claims made by a state agency for covered expenses paid under a state medical program within the timeline set forth in Code of Federal Regulations, title 42, section 447.45(d)(4).
(g) A health insurer may request a refund of a claim paid in error to the Department of Human Services within two years of the date the payment was made to the department. A request for a refund shall not be honored by the department if the health insurer makes the request after the time period has lapsed.
1975 c 247 s 1; 1979 c 174 s 1; 1989 c 282 art 3 s 1; 1990 c 426 art 2 s 2; 1992 c 549 art 4 s 19; 1Sp1993 c 1 art 5 s 1; 1995 c 207 art 10 s 1; 1997 c 225 art 2 s 62; 1999 c 139 art 4 s 2; 1999 c 245 art 4 s 1; 2004 c 228 art 1 s 75; 2006 c 282 art 17 s 1; 2010 c 310 art 13 s 1; 2015 c 71 art 11 s 1; 2016 c 158 art 2 s 7
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62A — Accident And Health Insurance
Section 62A.011 — Definitions.
Section 62A.02 — Policy Forms.
Section 62A.021 — Health Care Policy Rates.
Section 62A.023 — Notice Of Rate Change.
Section 62A.024 — Explanations Of Rate Increases; Attribution To Statutory Changes.
Section 62A.03 — General Provisions Of Policy.
Section 62A.04 — Standard Provisions.
Section 62A.041 — Maternity Benefits.
Section 62A.0411 — Maternity Care.
Section 62A.042 — Family Coverage; Coverage Of Newborn Infants.
Section 62A.043 — Dental And Podiatric Coverage.
Section 62A.044 — Payments To Governmental Institutions.
Section 62A.045 — Payments On Behalf Of Enrollees In Government Health Programs.
Section 62A.046 — Coordination Of Benefits.
Section 62A.047 — Children's Health Supervision Services And Prenatal Care Services.
Section 62A.048 — Dependent Coverage.
Section 62A.049 — Limitation On Preauthorizations; Emergencies.
Section 62A.05 — Construction Of Provisions.
Section 62A.06 — Statements In Application.
Section 62A.07 — Rights Of Insurer, When Not Waived.
Section 62A.08 — Coverage Of Policy, Continuance In Force.
Section 62A.081 — Payments To Facilities Operated By State Or Local Government.
Section 62A.082 — Nondiscrimination In Access To Transplants.
Section 62A.095 — Subrogation Clauses Regulated.
Section 62A.096 — Notice To Insurer Of Subrogation Claim Required.
Section 62A.10 — Group Insurance.
Section 62A.105 — Coverages; Transfers To Substantially Similar Products.
Section 62A.11 — Blanket Accident And Sickness Insurance.
Section 62A.13 — Commercial Traveler Insurance Companies.
Section 62A.135 — Fixed Indemnity Policies; Minimum Loss Ratios.
Section 62A.136 — Hearing, Dental, And Vision Plan Coverage.
Section 62A.14 — Disabled Children.
Section 62A.141 — Coverage For Disabled Dependents.
Section 62A.145 — Survivor; Definition.
Section 62A.146 — Continuation Of Benefits To Survivors.
Section 62A.147 — Disabled Employees' Benefits; Definitions.
Section 62A.148 — Group Insurance; Provision Of Benefits For Disabled Employees.
Section 62A.149 — Benefits For Alcoholics And Drug Dependents.
Section 62A.15 — Coverage Of Certain Licensed Health Professional Services.
Section 62A.151 — Health Insurance Benefits For Emotionally Disabled Children.
Section 62A.152 — Benefits For Ambulatory Mental Health Services.
Section 62A.153 — Outpatient Medical And Surgical Services.
Section 62A.154 — Benefits For Des Related Conditions.
Section 62A.155 — Coverage For Services Provided To Ventilator-dependent Persons.
Section 62A.16 — Scope Of Certain Continuation And Conversion Requirements.
Section 62A.17 — Termination Of Or Layoff From Employment; Continuation And Conversion Rights.
Section 62A.18 — Prohibition Against Disability Offsets.
Section 62A.19 — Prohibition Against Nondiagnostic X-rays.
Section 62A.20 — Continuation Coverage Of Current Spouse And Children.
Section 62A.21 — Continuation And Conversion Privileges For Insured Former Spouses And Children.
Section 62A.22 — Refusal To Provide Coverage Because Of Option Under Workers' Compensation.
Section 62A.23 — Group Disability Income Coverage; Termination Without Prejudice; Definitions.
Section 62A.24 — Continuation Of Benefits.
Section 62A.25 — Reconstructive Surgery.
Section 62A.26 — Coverage For Phenylketonuria Treatment.
Section 62A.265 — Coverage For Lyme Disease.
Section 62A.27 — Coverage Of Adopted Children.
Section 62A.28 — Coverage For Scalp Hair Prostheses.
Section 62A.285 — Prohibited Underwriting; Breast Implants.
Section 62A.29 — Surety Bond Or Security For Certain Health Benefit Plans.
Section 62A.30 — Coverage For Diagnostic Procedures For Cancer.
Section 62A.302 — Coverage Of Dependents.
Section 62A.3021 — Coverage Of Dependents By Plans Other Than Health Plans.
Section 62A.303 — Prohibition; Severing Of Groups.
Section 62A.304 — Coverage For Port-wine Stain Elimination.
Section 62A.305 — Fibrocystic Condition; Termination Or Reduction Of Coverage.
Section 62A.306 — Use Of Gender Prohibited.
Section 62A.307 — Prescription Drugs; Equal Treatment Of Prescribers.
Section 62A.3075 — Cancer Chemotherapy Treatment Coverage.
Section 62A.308 — Hospitalization And Anesthesia For Dental Procedures.
Section 62A.3091 — Nondiscriminate Coverage Of Tests.
Section 62A.3092 — Equal Treatment Of Surgical First Assisting Services.
Section 62A.3093 — Coverage For Diabetes.
Section 62A.3094 — Coverage For Autism Spectrum Disorders.
Section 62A.3095 — Prescription Eye Drops Coverage.
Section 62A.3099 — Definitions.
Section 62A.31 — Medicare Supplement Benefits; Minimum Standards.
Section 62A.315 — Extended Basic Medicare Supplement Plan; Coverage.
Section 62A.316 — Basic Medicare Supplement Plan; Coverage.
Section 62A.3161 — Medicare Supplement Plan With 50 Percent Coverage.
Section 62A.3162 — Medicare Supplement Plan With 75 Percent Coverage.
Section 62A.3163 — Medicare Supplement Plan With 50 Percent Part A Deductible Coverage.
Section 62A.3164 — Medicare Supplement Plan With $20 And $50 Co-payment Medicare Part B Coverage.
Section 62A.3165 — Medicare Supplement Plan With High Deductible Coverage.
Section 62A.317 — Standards For Claims Payment.
Section 62A.318 — Medicare Select Policies And Certificates.
Section 62A.36 — Loss Ratio Standards.
Section 62A.37 — Government Certifications, Approvals, And Endorsements.
Section 62A.38 — Notice Of Free Examination.
Section 62A.40 — Replacement Regulated.
Section 62A.42 — Rulemaking Authority.
Section 62A.421 — Demonstration Projects.
Section 62A.43 — Limitations On Sales.
Section 62A.436 — Commissions.
Section 62A.44 — Applications.
Section 62A.451 — Definitions.
Section 62A.4511 — Certificate Of Authority Required.
Section 62A.4512 — Application For Certificate Of Authority.
Section 62A.4513 — Issuance Of Certificate Of Authority; Denial.
Section 62A.4514 — Filing Requirements For Authorized Entities.
Section 62A.4515 — Material Modifications.
Section 62A.4516 — Evidence Of Coverage.
Section 62A.4517 — Construction With Other Laws.
Section 62A.4518 — Nonduplication Of Coverage.
Section 62A.4519 — Complaint System.
Section 62A.4520 — Examination Of Organization.
Section 62A.4521 — Investments.
Section 62A.4523 — Protection Against Insolvency; Deposit.
Section 62A.4524 — Officer's And Employee's Fidelity Bond.
Section 62A.4526 — Suspension Or Revocation Of Certificate Of Authority.
Section 62A.4528 — Rehabilitation, Conservation, Or Liquidation.
Section 62A.48 — Long-term Care Policies.
Section 62A.49 — Home Care Services Coverage.
Section 62A.50 — Disclosures And Representations.
Section 62A.52 — Review Of Plan Of Care.
Section 62A.54 — Prohibited Practices.
Section 62A.60 — Retroactive Denial Of Expenses.
Section 62A.616 — Coverage For Nursing Home Care For Terminally Ill And Other Services.
Section 62A.62 — Demonstration Project.
Section 62A.64 — Health Insurance; Prohibited Agreements.
Section 62A.65 — Individual Market Regulation.
Section 62A.673 — Coverage Of Services Provided Through Telehealth.