Subdivision 1. Written disclosure. (a) A health plan company, as defined under section 62J.70, subdivision 3, a health care network cooperative as defined under section 62R.04, subdivision 3, and a health care provider as defined under section 62J.70, subdivision 2, shall, during open enrollment, upon enrollment, and annually thereafter, provide enrollees with a description of the general nature of the reimbursement methodologies used by the health plan company, health insurer, or health coverage plan to pay providers. The description must explain clearly any aspect of the reimbursement methodology that creates a financial incentive for the health care provider to limit or restrict the health care provided to enrollees. An entity required to disclose shall also disclose if no reimbursement methodology is used that creates a financial incentive for the health care provider to limit or restrict the health care provided to enrollees. This description may be incorporated into the member handbook, subscriber contract, certificate of coverage, or other written enrollee communication. The general reimbursement methodology shall be made available to employers at the time of open enrollment.
(b) Health plan companies, health care network cooperatives, and providers must, upon request, provide an enrollee with specific information regarding the reimbursement methodology, including, but not limited to, the following information:
(1) a concise written description of the provider payment plan, including any incentive plan applicable to the enrollee;
(2) a written description of any incentive to the provider relating to the provision of health care services to enrollees, including any compensation arrangement that is dependent on the amount of health coverage or health care services provided to the enrollee, or the number of referrals to or utilization of specialists; and
(3) a written description of any incentive plan that involves the transfer of financial risk to the health care provider.
(c) The disclosure statement describing the general nature of the reimbursement methodologies must comply with the Readability of Insurance Policies Act in chapter 72C and must be filed with and approved by the commissioner prior to its use.
(d) A disclosure statement that has been filed with the commissioner for approval under paragraph (c) is deemed approved 30 days after the date of filing, unless approved or disapproved by the commissioner on or before the end of that 30-day period.
(e) The disclosure statement describing the general nature of the reimbursement methodologies must be provided upon request in English, Spanish, Vietnamese, and Hmong. In addition, reasonable efforts must be made to provide information contained in the disclosure statement to other non-English-speaking enrollees.
(f) Health plan companies and providers may enter into agreements to determine how to respond to enrollee requests received by either the provider or the health plan company. This subdivision does not require disclosure of specific amounts paid to a provider, provider fee schedules, provider salaries, or other proprietary information of a specific health plan company or health insurer or health coverage plan or provider.
Subd. 2. Additional written disclosure of provider information. In the event a health plan company prepares a written disclosure as specified in subdivision 1, in a manner that explicitly makes a comparison of the financial incentives between the providers with whom it contracts, it must describe the incentives that occur at the provider level.
Subd. 3. Information on patients' medical bills. A health plan company and health care provider shall provide patients and enrollees with a copy of an explicit and intelligible bill whenever the patient or enrollee is sent a bill and is responsible for paying any portion of that bill. The bills must contain descriptive language sufficient to be understood by the average patient or enrollee. This subdivision does not apply to a flat co-pay paid by the patient or enrollee at the time the service is required.
Subd. 4. Nonapplicability. Health care providers as defined in section 62J.70, subdivision 2, clause (1), need not individually provide information required under this section if it has been provided by another individual or entity that is subject to this section.
1997 c 237 s 4; 1998 c 407 art 2 s 13
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62J — Health Care Cost Containment
Section 62J.016 — Goals Of Restructuring.
Section 62J.017 — Implementation Timetable.
Section 62J.04 — Monitoring The Rate Of Growth Of Health Care Spending.
Section 62J.041 — Interim Health Plan Company Cost Containment Goals.
Section 62J.052 — Provider Cost Disclosure.
Section 62J.06 — Immunity From Liability.
Section 62J.156 — Closed Committee Hearings.
Section 62J.17 — Expenditure Reporting.
Section 62J.212 — Public Health Goals.
Section 62J.22 — Participation Of Federal Programs.
Section 62J.23 — Provider Conflicts Of Interest.
Section 62J.25 — Mandatory Medicare Assignment.
Section 62J.26 — Evaluation Of Proposed Health Coverage Mandates.
Section 62J.2930 — Information Clearinghouse.
Section 62J.301 — Research And Data Initiatives.
Section 62J.311 — Analysis And Use Of Data.
Section 62J.321 — Data Collection And Processing Procedures.
Section 62J.38 — Cost Containment Data From Group Purchasers.
Section 62J.40 — Cost Containment Data From State Agencies And Other Governmental Units.
Section 62J.42 — Quality, Utilization, And Outcome Data.
Section 62J.431 — Evidence-based Health Care Guidelines.
Section 62J.46 — Monitoring And Reports.
Section 62J.48 — Criteria For Ambulance Services Reimbursement.
Section 62J.49 — Ambulance Services Financial Data.
Section 62J.495 — Electronic Health Record Technology.
Section 62J.496 — Electronic Health Record System Revolving Account And Loan Program.
Section 62J.497 — Electronic Prescription Drug Program.
Section 62J.498 — Health Information Exchange.
Section 62J.4981 — Certificate Of Authority To Provide Health Information Exchange Services.
Section 62J.4982 — Enforcement Authority; Compliance.
Section 62J.50 — Citation And Purpose.
Section 62J.52 — Establishment Of Uniform Billing Forms.
Section 62J.53 — Acceptance Of Uniform Billing Forms By Group Purchasers.
Section 62J.535 — Uniform Billing Requirements For Claim Transactions.
Section 62J.536 — Uniform Electronic Transactions And Implementation Guide Standards.
Section 62J.54 — Identification And Implementation Of Unique Identifiers.
Section 62J.55 — Privacy Of Unique Identifiers.
Section 62J.56 — Implementation Of Electronic Data Interchange Standards.
Section 62J.57 — Minnesota Center For Health Care Electronic Data Interchange.
Section 62J.581 — Standards For Minnesota Uniform Health Care Reimbursement Documents.
Section 62J.60 — Minnesota Uniform Health Care Identification Card.
Section 62J.61 — Rulemaking; Implementation.
Section 62J.62 — Electronic Billing Assistance.
Section 62J.63 — Center For Health Care Purchasing Improvement.
Section 62J.692 — Medical Education.
Section 62J.701 — Governmental Programs.
Section 62J.71 — Prohibited Provider Contracts.
Section 62J.72 — Disclosure Of Health Care Provider Information.
Section 62J.73 — Prohibition On Exclusive Arrangements.
Section 62J.76 — Nonpreemption.
Section 62J.81 — Disclosure Of Payments For Health Care Services.
Section 62J.812 — Primary Care Price Transparency.
Section 62J.82 — Hospital Information Reporting Disclosure.
Section 62J.823 — Hospital Pricing Transparency.
Section 62J.824 — Facility Fee Disclosure.