Title Minnesota Statutes, Minnesota Statutes

62Q.03 PROCESS FOR RISK ADJUSTMENT SYSTEM. § Subdivision 1.Purpose. The purpose of risk adjustment is to reduce the effects of risk selection on health insurance premiums by making monetary transfers from health plan companies that insure lower risk populations to health plan com…

62Q.075 LOCAL PUBLIC ACCOUNTABILITY AND COLLABORATION PLAN. § Subdivision 1. [Repealed by amendment, 2001 c 171 s 1] § Subd. 2.Requirement. Beginning October 31, 2004, all health maintenance organizations shall file a plan every four years with the commissioner of health describi…

62Q.096 CREDENTIALING OF PROVIDERS. (a) If a health plan company has initially credentialed, as providers in its provider network, individual providers employed by or under contract with an entity that: (1) is authorized to bill under section 256B.0625, subdivision 5; (2) is a me…

62Q.097 REQUIREMENTS FOR TIMELY PROVIDER CREDENTIALING. § Subdivision 1.Definitions. (a) The definitions in this subdivision apply to this section. (b) "Clean application for provider credentialing" or "clean application" means an application for provider credentialing submitted …

62Q.101 EVALUATION OF PROVIDER PERFORMANCE. A health plan company, or a vendor of risk management services as defined under section 60A.23, subdivision 8, shall, in evaluating the performance of a health care provider: (1) conduct the evaluation using a bona fide baseline based u…

62Q.1055 CHEMICAL DEPENDENCY. All health plan companies shall use the assessment criteria in section 245G.05 when assessing and treating enrollees for chemical dependency treatment. History: 1995 c 234 art 2 s 22; 2016 c 158 art 1 s 214; 2023 c 50 art 2 s 2

62Q.106 DISPUTE RESOLUTION BY COMMISSIONER. (a) A complainant may at any time submit a complaint to the appropriate commissioner to investigate. After investigating a complaint, or reviewing a company's decision, the appropriate commissioner may order a remedy as authorized under…

62Q.107 PROHIBITED PROVISION; JUDICIAL REVIEW. Beginning January 1, 1999, no health plan, including the coverages described in section 62A.011, subdivision 3, clauses (7) and (10), may specify a standard of review upon which a court may review denial of a claim or of any other de…

62Q.12 DENIAL OF ACCESS. No health plan company may deny access to a covered health care service unless the denial is made by, or under the direction of, or subject to the review of a health care professional licensed to provide the service in question. History: 1994 c 625 art 2 …

62Q.121 LICENSURE OF MEDICAL DIRECTORS. (a) No health plan company may employ a person as a medical director unless the person is licensed as a physician in this state. This section does not apply to a health plan company that is assessed less than three percent of the total amou…

62Q.135 CONTRACTING FOR CHEMICAL DEPENDENCY SERVICES. No health plan company shall contract with a chemical dependency treatment program, unless the program participates in the chemical dependency treatment accountability plan established by the commissioner of human services. Th…

62Q.137 CHEMICAL DEPENDENCY TREATMENT; COVERAGE. (a) Any health plan that provides coverage for chemical dependency treatment must cover chemical dependency treatment provided to an enrollee by the Department of Corrections while the enrollee is committed to the custody of the co…

62Q.14 RESTRICTIONS ON ENROLLEE SERVICES. No health plan company may restrict the choice of an enrollee as to where the enrollee receives services related to: (1) the voluntary planning of the conception and bearing of children; (2) the diagnosis of infertility; (3) the testing a…

62Q.16 MIDMONTH TERMINATION PROHIBITED. The termination of a person's coverage under any health plan as defined in section 62A.011, subdivision 3, with the exception of individual health plans, issued or renewed on or after January 1, 1995, must provide coverage until the end of …

62Q.165 UNIVERSAL COVERAGE. § Subdivision 1.Definition. It is the commitment of the state to achieve universal health coverage for all Minnesotans by the year 2011. Universal coverage is achieved when: (1) every Minnesotan has access to a full range of quality health care service…

62Q.17 VOLUNTARY PURCHASING POOLS. § Subdivision 1.Permission to form. Notwithstanding section 62A.10, employers, groups, and individuals may voluntarily form purchasing pools, solely for the purpose of negotiating and purchasing health plan coverage from health plan companies fo…

62Q.18 PORTABILITY OF COVERAGE. § Subdivision 1.Definition. For purposes of this section: (1) "continuous coverage" has the meaning given in section 62L.02, subdivision 9; (2) "guaranteed issue" means: (i) for individual health plans, that a health plan company shall not decline …

62Q.181 WRITTEN CERTIFICATION OF COVERAGE. A health plan company shall provide the written certifications of coverage required under United States Code, title 42, sections 300gg(e) and 300gg-43. This section applies only to coverage that is subject to regulation under state law a…

62Q.184 STEP THERAPY OVERRIDE. § Subdivision 1.Definitions. (a) For the purposes of this section, the terms in this subdivision have the meanings given them. (b) "Clinical practice guideline" means a systematically developed statement to assist health care providers and enrollees…

62Q.1841 PROHIBITION ON USE OF STEP THERAPY FOR METASTATIC CANCER. § Subdivision 1.Definitions. (a) For purposes of this section, the following definitions apply. (b) "Health plan" has the meaning given in section 62Q.01, subdivision 3. Health plan includes health coverage provid…

62Q.185 GUARANTEED RENEWABILITY; LARGE EMPLOYER GROUP. (a) No health plan company, as defined in section 62Q.01, subdivision 4, shall refuse to renew a health benefit plan, as defined in section 62L.02, subdivision 15, but issued to a large employer, as defined in section 62Q.18,…

62Q.186 PROHIBITION ON RESCISSIONS OF HEALTH PLANS. § Subdivision 1.Definitions. (a) "Rescission" means a cancellation or discontinuance of coverage under a health plan that has a retroactive effect. (b) "Rescission" does not include: (1) a cancellation or discontinuance of cover…

62Q.188 FLEXIBLE BENEFITS PLANS. § Subdivision 1.Definitions. For the purposes of this section, the terms used in this section have the meanings defined in section 62Q.01, except that "health plan" includes individual coverage and group coverage for employer plans with up to 100 …

62Q.19 ESSENTIAL COMMUNITY PROVIDERS. § Subdivision 1.Designation. (a) The commissioner shall designate essential community providers. The criteria for essential community provider designation shall be the following: (1) a demonstrated ability to integrate applicable supportive a…

62Q.22 HEALTH CARE SERVICES PREPAID OPTION. § Subdivision 1.Scope. A community health clinic that is designated as an essential community provider under section 62Q.19 and is associated with a hospital, a governmental unit, or the University of Minnesota may offer to individuals …

62Q.23 GENERAL SERVICES. (a) Health plan companies shall comply with all continuation and conversion of coverage requirements applicable to health maintenance organizations under state or federal law. (b) Health plan companies shall comply with sections 62A.047, 62A.27, and any o…

62Q.32 LOCAL OMBUDSPERSON. County board or community health service agencies may establish an office of ombudsperson to provide a system of consumer advocacy for persons receiving health care services through a health plan company. The ombudsperson's functions may include, but ar…

62Q.33 LOCAL GOVERNMENT PUBLIC HEALTH FUNCTIONS. § Subdivision 1.Findings. The legislature finds that the local government public health functions of community assessment, policy development, and assurance of service delivery are essential elements in consumer protection and in a…

62Q.37 AUDITS CONDUCTED BY INDEPENDENT ORGANIZATION. § Subdivision 1.Applicability. This section applies only to (1) a nonprofit health service plan corporation operating under chapter 62C; (2) a health maintenance organization operating under chapter 62D; (3) a community integra…

62Q.43 GEOGRAPHIC ACCESS. § Subdivision 1.Closed-panel health plan. For purposes of this section, "closed-panel health plan" means a health plan as defined in section 62Q.01 that requires an enrollee to receive all or a majority of primary care services from a specific clinic or …

62Q.45 COVERAGE FOR OUT-OF-AREA PRIMARY CARE. § Subdivision 1.Study. The commissioner of health shall develop methods to allow enrollees of managed care organizations to obtain primary care health services outside of the service area of their managed care organization, from healt…

62Q.451 UNRESTRICTED ACCESS TO SERVICES FOR THE DIAGNOSIS, MONITORING, AND TREATMENT OF RARE DISEASES. § Subdivision 1.Definitions. (a) For purposes of this section, the following terms have the meanings given. (b) "Rare disease or condition" means any disease or condition: (1) t…

62Q.46 PREVENTIVE ITEMS AND SERVICES. § Subdivision 1.Coverage for preventive items and services. (a) "Preventive items and services" has the meaning specified in the Affordable Care Act. Preventive items and services includes: (1) evidence-based items or services that have in ef…

62Q.465 MENTAL HEALTH PARITY AND SUBSTANCE ABUSE ACCOUNTABILITY OFFICE. (a) The Mental Health Parity and Substance Abuse Accountability Office is established within the Department of Commerce to create and execute effective strategies for implementing the requirements under: (1) …

62Q.47 ALCOHOLISM, MENTAL HEALTH, AND CHEMICAL DEPENDENCY SERVICES. (a) All health plans, as defined in section 62Q.01, that provide coverage for alcoholism, mental health, or chemical dependency services, must comply with the requirements of this section. (b) Cost-sharing requir…

62Q.471 EXCLUSION FOR SUICIDE ATTEMPTS PROHIBITED. (a) No health plan may exclude or reduce coverage for health care for an enrollee who is otherwise covered under the health plan on the basis that the need for the health care arose out of a suicide or suicide attempt by the enro…

62Q.472 SCREENING AND TESTING FOR OPIOIDS. (a) A health plan company shall not place a lifetime or annual limit on screenings and urinalysis testing for opioids for an enrollee in an inpatient or outpatient substance use disorder treatment program when the screening or testing is…

62Q.473 BIOMARKER TESTING. § Subdivision 1.Definitions. (a) For the purposes of this section, the terms defined in this subdivision have the meanings given. (b) "Biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological proc…

62Q.48 COST-SHARING IN PRESCRIPTION INSULIN DRUGS. § Subdivision 1.Scope of coverage. This section applies to all health plans issued or renewed to a Minnesota resident. § Subd. 2.Definitions. (a) For the purposes of this section, the terms defined in this subdivision have the me…

62Q.481 COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE. § Subdivision 1.Cost-sharing limits. (a) A health plan must limit the amount of any enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more tha…

62Q.49 ENROLLEE COST SHARING; NEGOTIATED PROVIDER PAYMENTS. § Subdivision 1.Applicability. This section applies to all health plans, as defined in section 62Q.01, subdivision 3, that provide coverage for health care to be provided entirely or partially: (1) through contracts in w…

62Q.50 PROSTATE CANCER SCREENING. A health plan must cover prostate cancer screening for men 40 years of age or over who are symptomatic or in a high-risk category and for all men 50 years of age or older. The screening must consist at a minimum of a prostate-specific antigen blo…

62Q.51 POINT-OF-SERVICE OPTION. § Subdivision 1.Definition. For purposes for this section, "point-of-service option" means a health plan under which the health plan company will reimburse an appropriately licensed or registered provider for providing covered services to an enroll…

62Q.52 DIRECT ACCESS TO OBSTETRIC AND GYNECOLOGIC SERVICES. § Subdivision 1.Direct access. (a) Health plan companies shall allow female enrollees direct access to providers who specialize in obstetrics and gynecology for the following services: (1) evaluation and necessary treatm…

62Q.521 POSTNATAL CARE. (a) For purposes of this section, "comprehensive postnatal visit" means a visit with a health care provider that includes a full assessment of the mother's and infant's physical, social, and psychological well-being, including but not limited to: mood and …

62Q.522 COVERAGE OF CONTRACEPTIVE METHODS AND SERVICES. § Subdivision 1.Definitions. (a) The definitions in this subdivision apply to this section. (b) "Contraceptive method" means a drug, device, or other product approved by the Food and Drug Administration to prevent unintended…