Subdivision 1. Provider agreement. Except for an employment agreement between a provider and health maintenance organization, an agreement to provide health care services between a provider and a health maintenance organization entered into or renewed after April 25, 1988, must contain the following provision:
PROVIDER AGREES NOT TO BILL, CHARGE, COLLECT A DEPOSIT FROM, SEEK REMUNERATION FROM, OR HAVE ANY RECOURSE AGAINST AN ENROLLEE OR PERSONS ACTING ON THEIR BEHALF FOR SERVICES PROVIDED UNDER THIS AGREEMENT. THIS PROVISION APPLIES TO BUT IS NOT LIMITED TO THE FOLLOWING EVENTS: (1) NONPAYMENT BY THE HEALTH MAINTENANCE ORGANIZATION OR (2) BREACH OF THIS AGREEMENT. THIS PROVISION DOES NOT PROHIBIT THE PROVIDER FROM COLLECTING CO-PAYMENTS OR FEES FOR UNCOVERED SERVICES.
THIS PROVISION SURVIVES THE TERMINATION OF THIS AGREEMENT FOR AUTHORIZED SERVICES PROVIDED BEFORE THIS AGREEMENT TERMINATES, REGARDLESS OF THE REASON FOR TERMINATION. THIS PROVISION IS FOR THE BENEFIT OF THE HEALTH MAINTENANCE ORGANIZATION ENROLLEES. THIS PROVISION DOES NOT APPLY TO SERVICES PROVIDED AFTER THIS AGREEMENT TERMINATES.
THIS PROVISION SUPERSEDES ANY CONTRARY ORAL OR WRITTEN AGREEMENT EXISTING NOW OR ENTERED INTO IN THE FUTURE BETWEEN THE PROVIDER AND THE ENROLLEE OR PERSONS ACTING ON THEIR BEHALF REGARDING LIABILITY FOR PAYMENT FOR SERVICES PROVIDED UNDER THIS AGREEMENT.
Subd. 2. Cooperation required. An agreement to provide health care services between a provider and a health maintenance organization must require the provider to cooperate with and participate in the health maintenance organization's quality assurance program, dispute resolution procedure, and utilization review program.
Subd. 3. Notice of termination. An agreement to provide health care services between a provider and a health maintenance organization must require that if the provider terminates the agreement, without cause, the provider shall give the organization 120 days' advance notice of termination.
Subd. 4. Late payments. If a health maintenance organization's payments to a provider are delayed beyond the payment date in the contract, the provider may notify the commissioner who shall consider that information in assessing the financial solvency of the health maintenance organization.
1988 c 612 s 21
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62D — Health Maintenance Organizations
Section 62D.01 — Citation And Purpose.
Section 62D.03 — Establishment Of Health Maintenance Organizations.
Section 62D.04 — Issuance Of Certificate Authority.
Section 62D.041 — Protection In The Event Of Insolvency.
Section 62D.042 — Initial Net Worth Requirement.
Section 62D.044 — Admitted Assets.
Section 62D.045 — Investment Restrictions.
Section 62D.05 — Powers Of Health Maintenance Organizations.
Section 62D.06 — Governing Body.
Section 62D.07 — Evidence Of Coverage; Required Terms.
Section 62D.08 — Annual Report.
Section 62D.09 — Information To Enrollees.
Section 62D.095 — Enrollee Cost Sharing.
Section 62D.10 — Provisions Applicable To All Health Plans.
Section 62D.101 — Continuation And Conversion Privileges For Former Spouses And Children.
Section 62D.102 — Family Therapy.
Section 62D.103 — Second Opinion Related To Substance Use Disorder And Mental Health.
Section 62D.104 — Required Out-of-area Conversion.
Section 62D.105 — Coverage Of Current Spouse, Former Spouse, And Children.
Section 62D.107 — Equal Access To Acupuncture Services.
Section 62D.109 — Services Associated With Clinical Trials.
Section 62D.11 — Complaint System.
Section 62D.115 — Quality Of Care Complaints.
Section 62D.12 — Prohibited Practices.
Section 62D.121 — Required Replacement Coverage.
Section 62D.123 — Provider Contracts.
Section 62D.124 — Geographic Accessibility.
Section 62D.13 — Powers Of Insurers And Nonprofit Health Service Plans.
Section 62D.14 — Examinations.
Section 62D.145 — Disclosure Of Information Held By Health Maintenance Organizations.
Section 62D.15 — Suspension Or Revocation Of Certificate Of Authority.
Section 62D.16 — Denial, Suspension, And Revocation; Administrative Procedures.
Section 62D.17 — Penalties And Enforcement.
Section 62D.18 — Rehabilitation Or Liquidation Of Health Maintenance Organization.
Section 62D.181 — Insolvency; Mcha Alternative Coverage.
Section 62D.182 — Liabilities.
Section 62D.19 — Unreasonable Expenses.
Section 62D.211 — Renewal Fee.
Section 62D.22 — Statutory Construction And Relationship To Other Laws.
Section 62D.23 — Filings And Reports As Public Documents.
Section 62D.24 — Commissioner Of Health's Authority To Contract.