Title Minnesota Statutes, Minnesota Statutes

62Q.527 NONFORMULARY ANTIPSYCHOTIC DRUGS; REQUIRED COVERAGE. § Subdivision 1.Definitions. (a) For purposes of this section, the following terms have the meanings given them. (b) "Mental illness" has the meaning given in sections 245.462, subdivision 20, paragraph (a), and 245.487…

62Q.528 DRUG COVERAGE IN EMERGENCY SITUATIONS. A health plan that provides prescription drug coverage must provide coverage for a prescription drug dispensed by a pharmacist under section 151.211, subdivision 3, under the terms of coverage that would apply had the prescription dr…

62Q.529 COVERAGE FOR DRUGS PRESCRIBED AND DISPENSED BY PHARMACIES. (a) A health plan that provides prescription coverage must provide coverage for self-administered hormonal contraceptives, nicotine replacement medications, and opiate antagonists for the treatment of an acute opi…

62Q.53 MENTAL HEALTH COVERAGE; MEDICALLY NECESSARY CARE. § Subdivision 1.Requirement. No health plan that covers mental health services may be offered, sold, issued, or renewed in this state that requires mental health services to satisfy a definition of "medically necessary care…

62Q.531 AMINO ACID-BASED FORMULA COVERAGE. § Subdivision 1.Definition. (a) For purposes of this section, the following term has the meaning given. (b) "Formula" means an amino acid-based elemental formula. § Subd. 2.Required coverage. A health plan company must provide coverage f…

62Q.535 COVERAGE FOR COURT-ORDERED MENTAL HEALTH SERVICES. § Subdivision 1.Mental health services. For purposes of this section, mental health services means all covered services that are intended to treat or ameliorate an emotional, behavioral, or psychiatric condition and that …

62Q.54 REFERRALS FOR RESIDENTS OF HEALTH CARE FACILITIES. If an enrollee is a resident of a health care facility licensed under chapter 144A or an assisted living facility licensed under chapter 144G, the enrollee's primary care provider must refer the enrollee to that facility's…

62Q.545 COVERAGE OF HOME CARE NURSING. (a) Home care nursing services, as provided under section 256B.0625, subdivision 7, with the exception of section 256B.0654, subdivision 4, shall be covered under a health plan for persons who are concurrently covered by both the health plan…

62Q.55 EMERGENCY SERVICES. § Subdivision 1.Access to emergency services. (a) Enrollees have the right to available and accessible emergency services, 24 hours a day and seven days a week. The health plan company shall inform its enrollees how to obtain emergency care for treatmen…

62Q.556 CONSUMER PROTECTIONS AGAINST BALANCE BILLING. § Subdivision 1.Nonparticipating provider balance billing prohibition. (a) Except as provided in paragraph (b), balance billing is prohibited when an enrollee receives services from: (1) a nonparticipating provider at a partic…

62Q.56 CONTINUITY OF CARE. § Subdivision 1.Change in health care provider; general notification. (a) If enrollees are required to access services through selected primary care providers for coverage, the health plan company shall prepare a written plan that provides for continuit…

62Q.57 DESIGNATION OF PRIMARY CARE PROVIDER. § Subdivision 1.Choice of primary care provider. (a) If a health plan company offering a group health plan, or an individual health plan that is not a grandfathered plan, requires or provides for the designation by an enrollee of a par…

62Q.58 ACCESS TO SPECIALTY CARE. § Subdivision 1.Standing referral. A health plan company shall establish a procedure by which an enrollee may apply for and, if appropriate, receive a standing referral to a health care provider who is a specialist if a referral to a specialist is…

62Q.585 GENDER-AFFIRMING CARE COVERAGE; MEDICALLY NECESSARY CARE. § Subdivision 1.Requirement. No health plan that covers physical or mental health services may be offered, sold, issued, or renewed in this state that: (1) excludes coverage for medically necessary gender-affirming…

62Q.645 EFFICIENCY REPORTS AND DISTRIBUTION OF INFORMATION. (a) The commissioner may use reports submitted by health plan companies, service cooperatives, and the public employee insurance program created in section 43A.316 to compile entity specific administrative efficiency rep…

62Q.65 ACCESS TO PROVIDER DISCOUNTS. § Subdivision 1.Requirement. A high deductible health plan must, when used in connection with a medical savings account or health savings account, provide the enrollee access to any discounted provider fees for services covered by the high ded…

62Q.66 DURABLE MEDICAL EQUIPMENT COVERAGE. No health plan company that covers durable medical equipment may utilize medical coverage criteria for durable medical equipment that limits coverage solely to equipment used in the home. History: 1998 c 334 s 1

62Q.665 COVERAGE FOR ORTHOTIC AND PROSTHETIC DEVICES. § Subdivision 1.Definitions. (a) For the purposes of this section, the following terms have the meanings given. (b) "Accredited facility" means any entity that is accredited to provide comprehensive orthotic or prosthetic devi…

62Q.6651 MEDICAL NECESSITY AND NONDISCRIMINATION STANDARDS FOR COVERAGE OF PROSTHETICS OR ORTHOTICS. (a) When performing a utilization review for a request for coverage of prosthetic or orthotic benefits, a health plan company shall apply the most recent version of evidence-based…

62Q.666 INTERMITTENT CATHETERS. § Subdivision 1.Required coverage. A health plan must provide coverage for intermittent urinary catheters and insertion supplies if intermittent catheterization is recommended by the enrollee's health care provider. At least 180 intermittent cathet…

62Q.67 DISCLOSURE OF COVERED DURABLE MEDICAL EQUIPMENT. § Subdivision 1.Disclosure. A health plan company that covers durable medical equipment shall provide enrollees, and upon request prospective enrollees, written disclosure that includes the information set forth in subdivisi…

62Q.675 HEARING AIDS. A health plan must cover hearing aids for all individuals for hearing loss that is not correctable by other covered procedures. Coverage required under this section is limited to one hearing aid in each ear every three years. No special deductible, coinsuran…

62Q.676 MEDICATION THERAPY MANAGEMENT. A pharmacy benefit manager that provides prescription drug services must make available medication therapy management services for enrollees taking four or more prescriptions to treat or prevent two or more chronic medical conditions. For pu…

62Q.677 LIFETIME AND ANNUAL LIMITS. § Subdivision 1.Applicability and scope. Except as provided in subdivision 2, this section applies to a health plan company providing coverage under an individual or group health plan. For purposes of this section, essential health benefits is …

62Q.678 DEPENDENT CHILD NOTICE. Group health plans and health plan companies that offer group or individual health plans with dependent coverage must provide written notice to an enrollee with dependent child coverage that the dependent child's coverage ends when the child reache…

62Q.679 RELIGIOUS OBJECTIONS.§Subdivision 1.Definitions.(a) The definitions in this subdivision apply to this section.(b) "Closely held for-profit entity" means an entity that is not a nonprofit entity, has more than 50 percent of the value of its ownership interest owned directl…

62Q.68 DEFINITIONS. § Subdivision 1.Application. For purposes of sections 62Q.68 to 62Q.72, the terms defined in this section have the meanings given them. For purposes of sections 62Q.69 and 62Q.70, the term "health plan company" does not include an insurance company licensed un…

62Q.69 COMPLAINT RESOLUTION. § Subdivision 1.Establishment. Each health plan company must establish and maintain an internal complaint resolution process that meets the requirements of this section to provide for the resolution of a complaint initiated by a complainant. § Subd. 2…

62Q.70 APPEAL OF THE COMPLAINT DECISION. § Subdivision 1.Establishment. (a) Each health plan company shall establish an internal appeal process for reviewing a health plan company's decision regarding a complaint filed in accordance with section 62Q.69. The appeal process must me…

62Q.71 NOTICE TO ENROLLEES. Each health plan company shall provide to enrollees a clear and concise description of its complaint resolution procedure, if applicable under section 62Q.68, subdivision 1, and the procedure used for utilization review as defined under chapter 62M as …

62Q.72 RECORD KEEPING; REPORTING. § Subdivision 1.Record keeping. Each health plan company shall maintain records of all enrollee complaints and their resolutions. These records shall be retained for five years and shall be made available to the appropriate commissioner upon requ…

62Q.73 EXTERNAL REVIEW OF ADVERSE DETERMINATIONS. § Subdivision 1.Definition. For purposes of this section, "adverse determination" means: (1) for individual health plans, a complaint decision relating to a health care service or claim that is partially or wholly adverse to the c…

62Q.731 APPEAL FROM ADVERSE DETERMINATION. § Subdivision 1.Definitions. (a) For purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Enrollee" means an eligible person as defined in section 62E.02, subdivision 13, and who meets the eligibi…

62Q.732 CITATION. Sections 62Q.732 to 62Q.75 may be cited as the "Minnesota Health Plan Contracting Act." History: 2004 c 246 s 2

62Q.733 DEFINITIONS. § Subdivision 1.Applicability. For purposes of sections 62Q.732 to 62Q.739, the following definitions apply. § Subd. 2.Contract. "Contract" means a written agreement between a health care provider and a health plan company to provide health care services. § S…

62Q.734 EXEMPTION. Sections 62Q.735 to 62Q.739 and 62Q.74 do not apply to health plan companies whose annual Minnesota health premium revenues are less than three percent of the total annual Minnesota health premium revenues, as measured by the assessment base of the Minnesota Co…

62Q.735 PROVIDER CONTRACTING PROCEDURES. § Subdivision 1.Contract disclosure. (a) Before requiring a health care provider to sign a contract, a health plan company shall give to the provider a complete copy of the proposed contract, including: (1) all attachments and exhibits; (2…

62Q.736 PAYMENT RATES. A contract between a health plan company and a provider shall comply with section 62A.64. History: 2004 c 246 s 6

62Q.737 SERVICE CODE CHANGES. (a) For purposes of this section, "service code" means current procedural terminology (CPT), current dental terminology (CDT), ICD-CM, diagnosis-related groups (DRGs), or other coding system. (b) The health plan company shall determine the manner in …

62Q.739 UNILATERAL TERMS PROHIBITED. (a) A contract between a health plan company and a health care provider shall not contain or require unilateral terms regarding indemnification or arbitration. Notwithstanding any prohibitions in this section, a contract between a health plan …

62Q.74 NETWORK SHADOW CONTRACTING. § Subdivision 1.Definitions. (a) For purposes of this section, "category of coverage" means one of the following types of health-related coverage: (1) health; (2) no-fault automobile medical benefits; or (3) workers' compensation medical benefit…

62Q.746 ACCESS TO CERTAIN INFORMATION REGARDING PROVIDERS. Upon request of the commissioner, a health plan company licensed under chapters 62C and 62D must provide the following information: (1) a detailed description of the health plan company's methods and procedures, standards…

62Q.75 PROMPT PAYMENT REQUIRED. § Subdivision 1.Definitions. (a) For purposes of this section, the following terms have the meanings given to them. (b) "Clean claim" means a claim that has no defect or impropriety, including any lack of any required substantiating documentation, …

62Q.751 COLLECTING DEDUCTIBLES AND COINSURANCE. A health plan company shall not prohibit providers from collecting deductibles and coinsurance from patients at or prior to the time of service. Providers may not withhold a service to a health plan company enrollee based on a patie…

62Q.76 DEFINITIONS. § Subdivision 1.Applicability. For purposes of sections 62Q.76 to 62Q.79, the terms defined in this section have the meanings given them. § Subd. 2.Dental care services. "Dental care services" means services performed by a licensed dentist or any person workin…

62Q.77 TERMS OF COVERAGE DISCLOSURE. A dental organization shall make available to an enrollee, upon request, a clear and concise description of the following terms of coverage: (1) the dental care services and other benefits to which the enrollee is entitled under the dental pla…