reglab/housing_qa huggingface dataset:
MN Stat § 62J.82 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62J — Health Care Cost Containment|Section 62J.82 — Hospital Information Reporting Disclosure.

62J.82 HOSPITAL INFORMATION REPORTING DISCLOSURE. Subdivision 1. Required information. The Minnesota Hospital Association shall develop a web-based system, available to the public free of charge, for reporting the following, for Minnesota residents: (1) hospital-specific performance on the measures of care developed under section 256B.072 for acute myocardial infarction, heart failure, and pneumonia; (2) by January 1, 2009, hospital-specific performance on the public reporting measures for hospital-acquired infections as published by the National Quality Forum and collected by the Minnesota Hospital Association and Stratis Health in collaboration with infection control practitioners; and (3) charge information, including, but not limited to, number of discharges, average length of stay, average charge, average charge per day, and median charge, for each of the 50 most common inpatient diagnosis-related groups and the 25 most common outpatient surgical procedures as specified by the Minnesota Hospital Association. Subd. 2. Website. The website must provide information that compares hospital-specific data to hospital statewide data. The website must be updated annually. The commissioner shall provide a link to this reporting information on the department's website. Subd. 3. Enforcement. The commissioner shall provide a link to this information on the department's website. If a hospital does not provide this information to the Minnesota Hospital Association, the commissioner of health may require the hospital to do so in accordance with section 144.55, subdivision 6. History:  1Sp2005 c 4 art 8 s 2; 2007 c 147 art 14 s 1
MN Stat § 62J.823 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62J — Health Care Cost Containment|Section 62J.823 — Hospital Pricing Transparency.

62J.823 HOSPITAL PRICING TRANSPARENCY. Subdivision 1. Short title. This section may be cited as the "Hospital Pricing Transparency Act." Subd. 2. Definition. For the purposes of this section, "estimate" means the actual price expected to be billed to the individual or to the individual's health plan company based on the specific diagnostic-related group code or specific procedure code or codes, reflecting any known discounts the individual would receive. Subd. 3. Applicability and scope. Any hospital, as defined in section 144.696, subdivision 3, and outpatient surgical center, as defined in section 144.696, subdivision 4, shall provide a written estimate of the cost of a specific service or stay upon the request of a patient, doctor, advanced practice registered nurse, or the patient's representative. The request must include: (1) the health coverage status of the patient, including the specific health plan or other health coverage under which the patient is enrolled, if any; and (2) at least one of the following: (i) the specific diagnostic-related group code; (ii) the name of the procedure or procedures to be performed; (iii) the type of treatment to be received; or (iv) any other information that will allow the hospital or outpatient surgical center to determine the specific diagnostic-related group or procedure code or codes. Subd. 4. Estimate. (a) An estimate provided by the hospital or outpatient surgical center must contain: (1) the method used to calculate the estimate; (2) the specific diagnostic-related group or procedure code or codes used to calculate the estimate, and a description of the diagnostic-related group or procedure code or codes that is reasonably understandable to a patient; and (3) a statement indicating that the estimate, while accurate, may not reflect the actual billed charges and that the final bill may be higher or lower depending on the patient's specific circumstances. (b) The estimate may be provided in any method that meets the needs of the patient and the hospital or outpatient surgical center, including electronically; however, a paper copy must be provided if specifically requested. History:  2006 c 255 s 25; 2020 c 115 art 4 s 7
MN Stat § 62J.824 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62J — Health Care Cost Containment|Section 62J.824 — Facility Fee Disclosure.

62J.824 FACILITY FEE DISCLOSURE. (a) Prior to the delivery of nonemergency services, a provider-based clinic that charges a facility fee shall provide notice to any patient stating that the clinic is part of a hospital and the patient may receive a separate charge or billing for the facility component, which may result in a higher out-of-pocket expense. (b) Each health care facility must post prominently in locations easily accessible to and visible by patients, including on its website, a statement that the provider-based clinic is part of a hospital and the patient may receive a separate charge or billing for the facility, which may result in a higher out-of-pocket expense. (c) This section does not apply to laboratory services, imaging services, or other ancillary health services that are provided by staff who are not employed by the health care facility or clinic. (d) For purposes of this section: (1) "facility fee" means any separate charge or billing by a provider-based clinic in addition to a professional fee for physicians' services that is intended to cover building, electronic medical records systems, billing, and other administrative and operational expenses; and (2) "provider-based clinic" means the site of an off-campus clinic or provider office, located at least 250 yards from the main hospital buildings or as determined by the Centers for Medicare and Medicaid Services, that is owned by a hospital licensed under chapter 144 or a health system that operates one or more hospitals licensed under chapter 144, and is primarily engaged in providing diagnostic and therapeutic care, including medical history, physical examinations, assessment of health status, and treatment monitoring. This definition does not include clinics that are exclusively providing laboratory, x-ray, testing, therapy, pharmacy, or educational services and does not include facilities designated as rural health clinics. History:   2019 c 7 s 1
MN Stat § 62J.83 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62J — Health Care Cost Containment|Section 62J.83 — Reduced Payment Amounts Permitted.

62J.83 REDUCED PAYMENT AMOUNTS PERMITTED. (a) Notwithstanding any provision of chapter 148 or any other provision of law to the contrary, a health care provider may provide care to a patient at a discounted payment amount, including care provided for free. (b) This section does not apply in a situation in which the discounted payment amount is not permitted under federal law. History:  2006 c 255 s 26; 2008 c 344 s 56; 2009 c 86 art 1 s 88
MN Stat § 62K.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.01 — Title.

62K.01 TITLE. This chapter may be cited as the "Minnesota Health Plan Market Rules." History:  2013 c 84 art 2 s 2,17
MN Stat § 62K.02 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.02 — Purpose And Scope.

62K.02 PURPOSE AND SCOPE. Subdivision 1. Purpose. The market rules set forth in this chapter serve to clarify and provide guidance on the application of state law and certain requirements of the Affordable Care Act on all health carriers offering health plans in Minnesota, whether or not through MNsure, to ensure fair competition for all health carriers in Minnesota, to minimize adverse selection, and to ensure that health plans are offered in a manner that protects consumers and promotes the provision of high-quality affordable health care, and improved health outcomes. This chapter contains the regulatory requirements as specified in section 62V.05, subdivision 5, paragraph (b), and shall fully satisfy the requirements of section 62V.05, subdivision 5, paragraph (b). Subd. 2. Scope. (a) This chapter applies only to health plans offered in the individual market or the small group market. (b) This chapter applies to health carriers with respect to individual health plans and small group health plans, unless otherwise specified. (c) If a health carrier issues or renews individual or small group health plans in other states, this chapter applies only to health plans issued or renewed in this state to a Minnesota resident, or to cover a resident of the state, or issued or renewed to a small employer that is actively engaged in business in this state, unless otherwise specified. (d) This chapter does not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1b. History:  2013 c 84 art 2 s 3; 2013 c 108 art 1 s 67
MN Stat § 62K.03 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.03 — Definitions.

62K.03 DEFINITIONS. Subdivision 1. Applicability. For purposes of this chapter, the terms defined in this section have the meanings given. Subd. 2. Affordable Care Act. "Affordable Care Act" means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments, and any federal guidance or regulations issued under these acts. Subd. 3. Dental plan. "Dental plan" means a dental plan as defined in section 62Q.76, subdivision 3. Subd. 4. Enrollee. "Enrollee" means a natural person covered by a health plan and includes an insured policyholder, subscriber, contract holder, member, covered person, or certificate holder. Subd. 5. Health carrier. "Health carrier" means a health carrier as defined in section 62A.011, subdivision 2. Subd. 6. Health plan. "Health plan" means a health plan as defined in section 62A.011, subdivision 3. Subd. 7. Individual health plan. "Individual health plan" means an individual health plan as defined in section 62A.011, subdivision 4. Subd. 8. Limited-scope pediatric dental plan. "Limited-scope pediatric dental plan" means a dental plan meeting the requirements of section 9832(c)(2)(A) of the Internal Revenue Code of 1986, as amended, that provides only pediatric dental benefits meeting the requirements of the Affordable Care Act and is offered by a health carrier. A limited-scope pediatric dental plan includes a dental plan that is offered separately or in conjunction with an individual or small group health plan to individuals who have not attained the age of 19 years as of the beginning of the policy year or to a family. Subd. 9. MNsure. "MNsure" means MNsure as defined in section 62V.02. Subd. 10. Preferred provider organization. "Preferred provider organization" means a health plan that provides discounts to enrollees or subscribers for services they receive from certain health care providers. Subd. 11. Qualified health plan. "Qualified health plan" means a health plan that meets the definition in the Affordable Care Act and has been certified by the board of MNsure in accordance with chapter 62V to be offered through MNsure. Subd. 12. Small group health plan. "Small group health plan" means a health plan issued by a health carrier to a small employer as defined in section 62L.02, subdivision 26. History:  2013 c 84 art 2 s 4; 2013 c 108 art 1 s 67
MN Stat § 62K.04 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.04 — Market Rules; Violation.

62K.04 MARKET RULES; VIOLATION. Subdivision 1. Compliance. (a) A health carrier issuing an individual health plan to a Minnesota resident or a small group health plan to provide coverage to a small employer that is actively engaged in business in Minnesota shall meet all of the requirements set forth in this chapter. The failure to meet any of the requirements under this chapter constitutes a violation of section 72A.20. (b) The requirements of this chapter do not apply to short-term coverage as defined in section 62A.65, subdivision 7, or grandfathered plan coverage as defined in section 62A.011, subdivision 1c. Subd. 2. Penalties. In addition to any other penalties provided by the laws of this state or by federal law, a health carrier or any other person found to have violated any requirement of this chapter may be subject to the administrative procedures, enforcement actions, and penalties provided under section 45.027 and chapters 62D and 72A. History:   2013 c 84 art 2 s 5
MN Stat § 62K.05 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.05 — Federal Act; Compliance Required.

62K.05 FEDERAL ACT; COMPLIANCE REQUIRED. A health carrier shall comply with all provisions of the Affordable Care Act to the extent that it imposes a requirement that applies in this state. Compliance with any provision of the Affordable Care Act is required as of the effective date established for that provision in the federal act, except as otherwise specifically stated earlier in state law. History:   2013 c 84 art 2 s 6
MN Stat § 62K.06 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.06 — Metal Level Mandatory Offerings.

62K.06 METAL LEVEL MANDATORY OFFERINGS. Subdivision 1. Identification. A health carrier that offers individual or small group health plans in Minnesota must provide documentation to the commissioner of commerce to justify actuarial value levels as specified in section 1302(d) of the Affordable Care Act for all individual and small group health plans offered inside and outside of MNsure. Subd. 2. Minimum levels. (a) A health carrier that offers a catastrophic plan or a bronze level health plan within a service area in either the individual or small group market must also offer a silver level and a gold level health plan in that market and within that service area. (b) A health carrier with less than five percent market share in the respective individual or small group market in Minnesota is exempt from paragraph (a), until January 1, 2017, unless the health carrier offers a qualified health plan through MNsure. If the health carrier offers a qualified health plan through MNsure, the health carrier must comply with paragraph (a). Subd. 3. MNsure restriction. MNsure may not, by contract or otherwise, mandate the types of health plans to be offered by a health carrier to individuals or small employers purchasing health plans outside of MNsure. Solely for purposes of this subdivision, "health plan" includes coverage that is excluded under section 62A.011, subdivision 3, clause (6). Subd. 4. Metal level defined. For purposes of this section, the metal levels and catastrophic plans are defined in section 1302(d) and (e) of the Affordable Care Act. Subd. 5. Enforcement. The commissioner of commerce shall enforce this section. History:  2013 c 84 art 2 s 7,17; 2013 c 108 art 1 s 67
MN Stat § 62K.075 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.075 — Provider Network Notifications.

62K.075 PROVIDER NETWORK NOTIFICATIONS. (a) A health carrier must provide on the carrier's website the provider network for each product offered by the carrier, and must update the carrier's website at least once a month with any changes to the carrier's provider network, including provider changes from in-network status to out-of-network status. A health carrier must also provide on the carrier's website, for each product offered by the carrier, a list of the current waivers of the requirements in section 62K.10, subdivision 2 or 3, in a format that is easily accessed and searchable by enrollees and prospective enrollees. (b) Upon notification from an enrollee, a health carrier must reprocess any claim for services provided by a provider whose status has changed from in-network to out-of-network as an in-network claim if the service was provided after the network change went into effect but before the change was posted as required under paragraph (a) unless the health carrier notified the enrollee of the network change prior to the service being provided. This paragraph does not apply if the health carrier is able to verify that the health carrier's website displayed the correct provider network status on the health carrier's website at the time the service was provided. (c) The limitations of section 62Q.56, subdivision 2a, shall apply to payments required by paragraph (b). History:  2016 c 179 s 1; 1Sp2019 c 9 art 8 s 9
MN Stat § 62K.08 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.08 — Marketing Standards.

62K.08 MARKETING STANDARDS. Subdivision 1. Marketing. (a) A health carrier offering individual or small group health plans must comply with all applicable provisions of the Affordable Care Act, including, but not limited to, the following: (1) compliance with all state laws pertaining to the marketing of individual or small group health plans; and (2) establishing marketing practices and benefit designs that will not have the effect of discouraging the enrollment of individuals with significant health needs in the health plan. (b) No marketing materials may lead consumers to believe that all health care needs will be covered. Subd. 2. Enforcement. The commissioner of commerce shall enforce this section. History:   2013 c 84 art 2 s 9
MN Stat § 62K.09 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.09 — Accreditation Standards.

62K.09 ACCREDITATION STANDARDS. Subdivision 1. Accreditation; general. (a) A health carrier that offers any individual or small group health plans in Minnesota outside of MNsure must be accredited in accordance with this subdivision. A health carrier must obtain accreditation through URAC, the National Committee for Quality Assurance (NCQA), or any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans by January 1, 2018. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner of health. (b) A health carrier that rents a provider network is exempt from this subdivision, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota. Subd. 2. Accreditation; MNsure. (a) MNsure shall require all health carriers offering a qualified health plan through MNsure to obtain the appropriate level of accreditation no later than the third year after the first year the health carrier offers a qualified health plan through MNsure. A health carrier must take the first step of the accreditation process during the first year in which it offers a qualified health plan. A health carrier that offers a qualified health plan on January 1, 2014, must obtain accreditation by the end of the 2016 plan year. (b) To the extent a health carrier cannot obtain accreditation due to low volume of enrollees, an exception to this accreditation criterion may be granted by MNsure until such time as the health carrier has a sufficient volume of enrollees. Subd. 3. Oversight. A health carrier shall comply with a request from the commissioner of health to confirm accreditation or progress toward accreditation. Subd. 4. Enforcement. The commissioner of health shall enforce this section. History:  2013 c 84 art 2 s 10,17; 2013 c 108 art 1 s 67
MN Stat § 62K.105 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.105 — Network Adequacy Complaints.

62K.105 NETWORK ADEQUACY COMPLAINTS. The commissioner of health shall establish a clear, easily accessible process for accepting complaints from enrollees regarding health carrier compliance with section 62K.10, subdivision 2, 3, or 4. Using this process, an enrollee may file a complaint with the commissioner that a health carrier is not in compliance with the requirements of section 62K.10, subdivision 2, 3, or 4. The commissioner of health shall investigate all complaints received under this section. History:   1Sp2019 c 9 art 8 s 11
MN Stat § 62K.11 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.11 — Balance Billing Prohibited.

62K.11 BALANCE BILLING PROHIBITED. (a) A network provider is prohibited from billing an enrollee for any amount in excess of the allowable amount the health carrier has contracted for with the provider as total payment for the health care service. A network provider is permitted to bill an enrollee the approved co-payment, deductible, or coinsurance. (b) A network provider is permitted to bill an enrollee for services not covered by the enrollee's health plan as long as the enrollee agrees in writing in advance before the service is performed to pay for the noncovered service. History:   2013 c 84 art 2 s 12
MN Stat § 62K.12 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62K — Minnesota Health Plan Market Rules|Section 62K.12 — Quality Assurance And Improvement.

62K.12 QUALITY ASSURANCE AND IMPROVEMENT. Subdivision 1. General. (a) All health carriers offering an individual health plan or small group health plan must have a written internal quality assurance and improvement program that, at a minimum: (1) provides for ongoing evaluation of the quality of health care provided to its enrollees; (2) periodically reports the evaluation of the quality of health care to the health carrier's governing body; (3) follows policies and procedures for the selection and credentialing of network providers that is consistent with community standards; (4) conducts focused studies directed at problems, potential problems, or areas with potential for improvements in care; (5) conducts enrollee satisfaction surveys and monitors oral and written complaints submitted by enrollees or members; and (6) collects and reports Health Effectiveness Data and Information Set (HEDIS) measures and conducts other quality assessment and improvement activities as directed by the commissioner of health. (b) The commissioner of health shall submit a report to the chairs and ranking minority members of senate and house of representatives committees with primary jurisdiction over commerce and health policy by February 15, 2015, with recommendations for specific quality assurance and improvement standards for all Minnesota health carriers. The recommended standards must not require duplicative data gathering, analysis, or reporting by health carriers. Subd. 2. Exemption. A health carrier that rents a provider network is exempt from this section, unless it is part of a holding company as defined in section 60D.15 that in aggregate exceeds ten percent market share in either the individual or small group market in Minnesota. Subd. 3. Waiver. A health carrier that has obtained accreditation through the URAC for network management; quality improvement; credentialing; member protection; and utilization management, or has achieved an excellent or commendable level ranking from the National Committee for Quality Assurance (NCQA), shall be deemed to meet the requirements of subdivision 1. Proof of accreditation must be submitted to the commissioner of health in a form prescribed by the commissioner. The commissioner may adopt rules to recognize similar accreditation standards from any entity recognized by the United States Department of Health and Human Services for accreditation of health insurance issuers or health plans. Subd. 4. Enforcement. The commissioner of health shall enforce this section. History:  2013 c 84 art 2 s 13,17