reglab/housing_qa huggingface dataset:
MN Stat § 62Q.52 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.52 — Direct Access To Obstetric And Gynecologic Services.

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 treatment for obstetric conditions or emergencies; (2) maternity care; and (3) evaluation and necessary treatment for gynecologic conditions or emergencies, including annual preventive health examinations. (b) For purposes of this section, "direct access" means that a female enrollee may obtain the obstetric and gynecologic services specified in paragraph (a) from providers who specialize in obstetrics and gynecology in the enrollee's network without a referral from, or prior approval through a primary care provider, another physician, the health plan company, or its representatives. (c) The health plan company shall treat the provision of obstetrical and gynecological care and the ordering of related obstetrical and gynecological items and services, pursuant to paragraph (a), by a participating health care provider who specializes in obstetrics or gynecology as the authorization of a primary care provider. (d) The health plan company may require the health care provider to agree to otherwise adhere to the health plan company's policies and procedures, including procedures for obtaining prior authorization and for providing services in accordance with a treatment plan, if any, approved by the health plan company. (e) Health plan companies shall not require higher co-payments, coinsurance, deductibles, or other enrollee cost-sharing for direct access. (f) This section applies only to services described in paragraph (a) that are covered by the enrollee's coverage, but coverage of a preventive health examination for female enrollees must not exclude coverage of a gynecologic examination. (g) For purposes of this section, a health care provider who specializes in obstetrics or gynecology means any individual, including an individual other than a physician, who is authorized under state law to provide obstetrical or gynecological care. (h) This section does not: (1) waive any exclusions of coverage under the terms and conditions of the health plan with respect to coverage of obstetrical or gynecological care; or (2) preclude the health plan company from requiring that the participating health care provider providing obstetrical or gynecological care notify the primary care provider or the health plan company of treatment decisions. Subd. 2. Notice. A health plan company shall provide notice to enrollees of the provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act. Subd. 3. Enforcement. The commissioner of health shall enforce this section. History:  1997 c 26 s 1; 2013 c 84 art 1 s 76
MN Stat § 62Q.528 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.528 — Drug Coverage In Emergency Situations.

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 drug been dispensed according to a prescription. History:   1Sp2019 c 9 art 9 s 2
MN Stat § 62Q.529 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.529 — Coverage For Drugs Prescribed And Dispensed By Pharmacies.

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 opiate overdose prescribed and dispensed by a licensed pharmacist in accordance with section 151.37, subdivision 14, 15, or 16, under the same terms of coverage that would apply had the prescription drug been prescribed by a licensed physician, physician assistant, or advanced practice nurse practitioner. (b) A health plan is not required to cover the drug if dispensed by an out-of-network pharmacy, unless the health plan covers prescription drugs dispensed by out-of-network pharmacies. History:   2020 c 115 art 2 s 2
MN Stat § 62Q.53 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.53 — Mental Health Coverage; Medically Necessary Care.

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," "medical necessity," or similar term that is more restrictive with respect to mental health than the definition provided in subdivision 2. Subd. 2. Minimum definition. "Medically necessary care" means health care services appropriate, in terms of type, frequency, level, setting, and duration, to the enrollee's diagnosis or condition, and diagnostic testing and preventive services. Medically necessary care must be consistent with generally accepted practice parameters as determined by health care providers in the same or similar general specialty as typically manages the condition, procedure, or treatment at issue and must: (1) help restore or maintain the enrollee's health; or (2) prevent deterioration of the enrollee's condition. Subd. 3. Health plan; definition. For purposes of this section, "health plan" has the meaning given in section 62Q.01, subdivision 3, but includes the coverages listed in section 62A.011, subdivision 3, clauses (7) and (10). History:   1997 c 49 s 1
MN Stat § 62Q.535 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.535 — Coverage For Court-ordered Mental Health Services.

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 are covered by the policy, contract, or certificate of coverage of the enrollee's health plan company or by law. Subd. 2. Coverage required. (a) All health plan companies that provide coverage for mental health services must cover or provide mental health services ordered by a court of competent jurisdiction under a court order that is issued on the basis of a behavioral care evaluation performed by a licensed psychiatrist or a doctoral level licensed psychologist, which includes a diagnosis and an individual treatment plan for care in the most appropriate, least restrictive environment. The health plan company must be given a copy of the court order and the behavioral care evaluation. The health plan company shall be financially liable for the evaluation if performed by a participating provider of the health plan company and shall be financially liable for the care included in the court-ordered individual treatment plan if the care is covered by the health plan and ordered to be provided by a participating provider or another provider as required by rule or law. This court-ordered coverage must not be subject to a separate medical necessity determination by a health plan company under its utilization procedures. (b) A party or interested person, including a health plan company or its designee, may make a motion for modification of the court-ordered plan of care pursuant to the applicable rules of procedure for modification of the court's order. The motion may include a request for a new behavioral care evaluation according to this section. History:  1Sp2001 c 9 art 9 s 3; 2002 c 379 art 1 s 113
MN Stat § 62Q.54 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.54 — Referrals For Residents Of Health Care Facilities.

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 skilled nursing unit or that facility's appropriate care setting, provided that the health plan company and the provider can best meet the patient's needs in that setting, if the following conditions are met: (1) the facility agrees to be reimbursed at that health plan company's contract rate negotiated with similar providers for the same services and supplies; and (2) the facility meets all guidelines established by the health plan company related to quality of care, utilization, referral authorization, risk assumption, use of health plan company network, and other criteria applicable to providers under contract for the same services and supplies. History:  1997 c 225 art 2 s 45; 2020 c 115 art 4 s 11; 7Sp2020 c 1 art 6 s 25
MN Stat § 62Q.545 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.545 — Coverage Of Home Care Nursing.

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 and enrolled in medical assistance under chapter 256B. (b) For purposes of this section, a period of home care nursing services may be subject to the co-payment, coinsurance, deductible, or other enrollee cost-sharing requirements that apply under the health plan. Cost-sharing requirements for home care nursing services must not place a greater financial burden on the insured or enrollee than those requirements applied by the health plan to other similar services or benefits. Nothing in this section is intended to prevent a health plan company from requiring prior authorization by the health plan company for such services as required by section 256B.0625, subdivision 7, or use of contracted providers under the applicable provisions of the health plan. History:  1Sp2010 c 1 art 19 s 1; 2014 c 291 art 9 s 5
MN Stat § 62Q.57 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.57 — Designation Of Primary Care Provider.

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 participating primary care provider, the health plan company shall permit each enrollee to: (1) designate any participating primary care provider available to accept the enrollee; and (2) for a child, designate any participating physician or advanced practice registered nurse who specializes in pediatrics as the child's primary care provider and is available to accept the child. (b) This section does not waive any exclusions of coverage under the terms and conditions of the health plan with respect to coverage of pediatric care. Subd. 2. Notice. A health plan company shall provide notice to enrollees of the provisions of subdivision 1 in accordance with the requirements of the Affordable Care Act. Subd. 3. Enforcement. The commissioner shall enforce this section. History:  2013 c 84 art 1 s 79; 2020 c 115 art 4 s 12
MN Stat § 62Q.645 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.645 — Efficiency Reports And Distribution Of Information.

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 reports; may make these reports available on state agency websites, including minnesotahealthinfo.com; and may include information on: (1) number of covered lives; (2) covered services; (3) geographic availability; (4) whom to contact to obtain current premium rates; (5) administrative costs, using the definition of administrative costs developed under section 62J.38; (6) Internet links to information on the health plan, if available; and (7) any other information about the health plan identified by the commissioner as being useful for employers, consumers, providers, and others in evaluating health plan options. (b) This section does not apply to a health plan company unless its annual Minnesota premiums exceed $50,000,000 based on the most recent assessment base of the Minnesota Comprehensive Health Association. For purposes of this determination, the premiums of a health plan company include those of its affiliates. History:   2006 c 255 s 34
MN Stat § 62Q.65 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.65 — Access To Provider Discounts.

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 deductible health plan, regardless of whether the enrollee has satisfied the deductible for the high deductible health plan. Subd. 2. Definitions. For purposes of this section, the following terms have the meanings given: (1) "high deductible health plan" has the meaning given under the Internal Revenue Code of 1986, section 220(c)(2), with respect to a medical savings account; and the meaning given under Internal Revenue Code of 1986, section 223(c)(2), with respect to a health savings account; (2) "medical savings account" has the meaning given under the Internal Revenue Code of 1986, section 220(d)(1); (3) "discounted provider fees" means fees contained in a provider agreement entered into by the issuer of the high deductible health plan, or an affiliate of the issuer, for use in connection with the high deductible health plan; and (4) "health savings account" has the meaning given under the Internal Revenue Code of 1986, section 223(d). History:  1997 c 225 art 2 s 46; 2005 c 132 s 17
MN Stat § 62Q.66 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.66 — Durable Medical Equipment Coverage.

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
MN Stat § 62Q.67 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.67 — Disclosure Of Covered Durable Medical Equipment.

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 subdivision 2. The health plan company may include the information in the member contract, certificate of coverage, schedule of payments, member handbook, or other written enrollee communication. Subd. 2. Information to be disclosed. A health plan company that covers durable medical equipment shall disclose the following information: (1) general descriptions of the coverage for durable medical equipment, level of coverage available, and criteria and procedures for any required prior authorizations; and (2) the address and telephone number of a health plan representative whom an enrollee may contact to obtain specific information verbally, or upon request in writing, about prior authorization including criteria used in making coverage decisions and information on limitations or exclusions for durable medical equipment. History:   1998 c 334 s 2
MN Stat § 62Q.675 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.675 — Hearing Aids; Persons 18 Or Younger.

62Q.675 HEARING AIDS; PERSONS 18 OR YOUNGER. A health plan must cover hearing aids for individuals 18 years of age or younger 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, coinsurance, co-payment, or other limitation on the coverage under this section that is not generally applicable to other coverages under the plan may be imposed. History:  1Sp2003 c 14 art 7 s 24; 2007 c 60 s 1
MN Stat § 62Q.676 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.676 — Medication Therapy Management.

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 purposes of this section, "medication therapy management" means the provision of the following pharmaceutical care services by, or under the supervision of, a licensed pharmacist to optimize the therapeutic outcomes of the patient's medications: (1) performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events; (2) communicating essential information to the patient's other primary care providers; and (3) providing verbal education and training designed to enhance patient understanding and appropriate use of the patient's medications. Nothing in this section shall be construed to expand or modify the scope of practice of the pharmacist as defined in section 151.01, subdivision 27. History:   2009 c 79 art 4 s 7
MN Stat § 62Q.678 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.678 — Dependent Child Notice.

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 reaches the age of 26. Notice must be sent to the enrollee at the enrollee's last known address at least 60 days before the dependent child reaches the age of 26. The notice must include the date on which coverage ends and information on accessing the MNsure website as applicable. History:   2020 c 73 s 2
MN Stat § 62Q.68 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.68 — Definitions.

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 under chapter 60A to offer, sell, or issue a policy of accident and sickness insurance as defined in section 62A.01 or a nonprofit health service plan corporation regulated under chapter 62C that only provides dental coverage or vision coverage. For purposes of sections 62Q.69 through 62Q.73, the term "health plan company" does not include the Comprehensive Health Association created under chapter 62E. Section 62Q.70 does not apply to individual coverage. However, a health plan company offering individual coverage may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow the process outlined in section 62Q.70. Subd. 2. Complaint. "Complaint" means any grievance against a health plan company that is not the subject of litigation and that has been submitted by a complainant to a health plan company regarding the provision of health services including, but not limited to, the scope of coverage for health care services; retrospective denials or limitations of payment for services; eligibility issues; denials, cancellations, or nonrenewals of coverage; administrative operations; and the quality, timeliness, and appropriateness of health care services rendered. If the complaint is from an applicant, the complaint must relate to the application. If the complaint is from a former enrollee, the complaint must relate to services received during the period of time the individual was an enrollee. Any grievance requiring a medical determination in its resolution must have the medical determination aspect of the complaint processed under the appeal procedure described in section 62M.06. Subd. 3. Complainant. "Complainant" means an enrollee, applicant, or former enrollee, or anyone acting on behalf of an enrollee, applicant, or former enrollee, who submits a complaint. History:  1999 c 239 s 34; 2002 c 330 s 28; 2013 c 84 art 1 s 81
MN Stat § 62Q.70 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62Q — Health Plan Companies|Section 62Q.70 — Appeal Of The Complaint Decision.

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 meet the requirements of this section. This section applies only to group health plans. However, a health plan company offering individual coverage may, pursuant to section 62Q.69, subdivision 3, paragraph (c), follow the process outlined in this section. (b) The person or persons with authority to resolve or recommend the resolution of the internal appeal must not be solely the same person or persons who made the complaint decision under section 62Q.69. (c) The internal appeal process must permit the enrollee to review the information relied upon in the course of the appeal and the receipt of testimony, correspondence, explanations, or other information from the complainant, staff persons, administrators, providers, or other persons as deemed necessary by the person or persons investigating or presiding over the appeal. (d) The enrollee must be allowed to receive continued coverage pending the outcome of the appeals process. Subd. 2. Procedures for filing an appeal. The health plan company must provide notice to enrollees of its internal appeals process in a culturally and linguistically appropriate manner consistent with the provisions of the Affordable Care Act. If a complainant notifies the health plan company of the complainant's desire to appeal the health plan company's decision regarding the complaint through the internal appeal process, the health plan company must provide the complainant the option for the appeal to occur either in writing or by hearing. Subd. 3. Notification of appeal decisions. (a) If a complainant appeals in writing, the health plan company must give the complainant written notice of the appeal decision and all key findings within 30 days of the health plan company's receipt of the complainant's written notice of appeal. If a complainant appeals by hearing, the health plan company must give the complainant written notice of the appeal decision and all key findings within 45 days of the health plan company's receipt of the complainant's written notice of appeal. (b) If the appeal decision is partially or wholly adverse to the complainant, the notice must advise the complainant of the right to submit the appeal decision to the external review process described in section 62Q.73 and the procedure for initiating the external process. (c) Upon the request of the complainant, the health plan company must provide the complainant with a complete summary of the appeal decision. History:  1999 c 239 s 36; 2013 c 84 art 1 s 83,84