reglab/housing_qa huggingface dataset:
MN Stat § 62U.15 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62U — Health Care Payment And Pricing Reform|Section 62U.15 — Alzheimer's Disease; Prevalence And Screening Measures.

62U.15 ALZHEIMER'S DISEASE; PREVALENCE AND SCREENING MEASURES. Subdivision 1. Data from providers. (a) By July 1, 2012, the commissioner shall review currently available quality measures and make recommendations for future measurement aimed at improving assessment and care related to Alzheimer's disease and other dementia diagnoses, including improved rates and results of cognitive screening, rates of Alzheimer's and other dementia diagnoses, and prescribed care and treatment plans. (b) The commissioner may contract with a private entity to complete the requirements in this subdivision. If the commissioner contracts with a private entity already under contract through section 62U.02, then the commissioner may use a sole source contract and is exempt from competitive procurement processes. Subd. 2.  MS 2018 [Repealed, 2020 c 115 art 3 s 40] Subd. 3. Comparison data. The commissioner, with the commissioner of human services, the Minnesota Board on Aging, and other appropriate state offices, shall jointly review existing and forthcoming literature in order to estimate differences in the outcomes and costs of current practices for caring for those with Alzheimer's disease and other dementias, compared to the outcomes and costs resulting from: (1) earlier identification of Alzheimer's and other dementias; (2) improved support of family caregivers; and (3) improved collaboration between medical care management and community-based supports. Subd. 4. Reporting. By January 15, 2013, the commissioner must report to the legislature on progress toward establishment and collection of quality measures required under this section. History:   1Sp2011 c 9 art 2 s 4
MN Stat § 62V.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.01 — Title.

62V.01 TITLE. This chapter may be cited as the "MNsure Act." History:  2013 c 9 s 3; 2013 c 108 art 1 s 67
MN Stat § 62V.02 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.02 — Definitions.

62V.02 DEFINITIONS. Subdivision 1. Scope. For the purposes of this chapter, the following terms have the meanings given. Subd. 2. Board. "Board" means the Board of Directors of MNsure specified in section 62V.04. Subd. 3. Dental plan. "Dental plan" has the meaning defined in section 62Q.76, subdivision 3. Subd. 4. Health plan. "Health plan" means a policy, contract, certificate, or agreement defined in section 62A.011, subdivision 3. Subd. 5. Health carrier. "Health carrier" has the meaning defined in section 62A.011. Subd. 6. Individual market. "Individual market" means the market for health insurance coverage offered to individuals. Subd. 7. Insurance producer. "Insurance producer" has the meaning defined in section 60K.31. Subd. 8. MNsure. "MNsure" means the state health benefit exchange as described in section 1311 of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act. Subd. 9. Navigator. "Navigator" has the meaning described in section 1311(i) of the federal Patient Protection and Affordable Care Act, Public Law 111-148, and further defined through amendments to the act and regulations issued under the act. Subd. 10. Public health care program. "Public health care program" means any public health care program administered by the commissioner of human services. Subd. 11. Qualified health plan. "Qualified health plan" means a health plan that meets the definition in section 1301(a) of the Affordable Care Act, Public Law 111-148, and has been certified by the board in accordance with section 62V.05, subdivision 5, to be offered through MNsure. Subd. 12. Small group market. "Small group market" means the market for health insurance coverage offered to small employers as defined in section 62L.02, subdivision 26. Subd. 13. Website. "Website" means a site maintained on the World Wide Web by MNsure that allows for access to information and services provided by MNsure. History:  2013 c 9 s 4; 2013 c 108 art 1 s 67
MN Stat § 62V.051 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.051 — Mnsure; Consumer Retroactive Appointment Of A Navigator Or Producer Permitted.

62V.051 MNSURE; CONSUMER RETROACTIVE APPOINTMENT OF A NAVIGATOR OR PRODUCER PERMITTED. Notwithstanding any other law or rule to the contrary, for up to six months after the effective date of the qualified health plan, MNsure must permit a qualified health plan policyholder, who has not designated a navigator or an insurance producer, to retroactively appoint a navigator or insurance producer. MNsure must provide notice of the retroactive appointment to the health carrier. The health carrier must retroactively pay commissions to the insurance producer if the producer can demonstrate that they were certified by MNsure at the time of the original enrollment, were appointed by the selected health carrier at the time of the enrollment, and that an agent of record agreement was executed prior to or at the time of the effective date of the policy. MNsure must adopt a standard form of agent of record agreement for purposes of this section. History:   2015 c 58 s 4
MN Stat § 62V.07 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.07 — Funds.

62V.07 FUNDS. (a) The MNsure account is created in the special revenue fund of the state treasury. All funds received by MNsure shall be deposited in the account. Funds in the account are appropriated to MNsure for the operation of MNsure. Notwithstanding section 11A.20, all investment income and all investment losses attributable to the investment of the MNsure account not currently needed, shall be credited to the MNsure account. (b) The budget submitted to the legislature under section 16A.11 must include budget information for MNsure. History:  2013 c 9 s 9; 2013 c 108 art 1 s 67
MN Stat § 62V.08 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.08 — Reports.

62V.08 REPORTS. (a) MNsure shall submit a report to the legislature by January 15, 2015, and each January 15 thereafter, on: (1) the performance of MNsure operations; (2) meeting MNsure responsibilities; (3) an accounting of MNsure budget activities; (4) practices and procedures that have been implemented to ensure compliance with data practices laws, and a description of any violations of data practices laws or procedures; and (5) the effectiveness of the outreach and implementation activities of MNsure in reducing the rate of uninsurance. (b) MNsure must publish its administrative and operational costs on a website to educate consumers on those costs. The information published must include: (1) the amount of premiums and federal premium subsidies collected; (2) the amount and source of revenue received under section 62V.05, subdivision 1, paragraph (b), clause (3); (3) the amount and source of any other fees collected for purposes of supporting operations; and (4) any misuse of funds as identified in accordance with section 3.975. The website must be updated at least annually. History:  2013 c 9 s 10; 2013 c 108 art 1 s 67
MN Stat § 62V.09 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.09 — Expiration And Sunset Exclusion.

62V.09 EXPIRATION AND SUNSET EXCLUSION. Notwithstanding section 15.059, the board and its advisory committees shall not expire, except as specified in section 62V.04, subdivision 13. The board and its advisory committees are not subject to review or sunsetting under chapter 3D. History:   2013 c 9 s 11
MN Stat § 62V.10 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.10 — Right Not To Participate.

62V.10 RIGHT NOT TO PARTICIPATE. Nothing in this chapter infringes on the right of a Minnesota citizen not to participate in MNsure. History:  2013 c 9 s 12; 2013 c 108 art 1 s 67
MN Stat § 62V.11 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62V — Mnsure|Section 62V.11 — Legislative Oversight Committee.

62V.11 LEGISLATIVE OVERSIGHT COMMITTEE. Subdivision 1. Legislative oversight. (a) The Legislative Oversight Committee is established to provide oversight to the implementation of this chapter and the operation of MNsure. (b) The committee shall review the operations of MNsure at least annually and shall recommend necessary changes in policy, implementation, and statutes to the board and to the legislature. (c) MNsure shall present to the committee the annual report required in section 62V.08, the appeals process under section 62V.05, subdivision 6, and the actions taken regarding the treatment of multiemployer plans. Subd. 2. Membership; meetings; compensation. (a) The Legislative Oversight Committee shall consist of five members of the senate, three members appointed by the majority leader of the senate, and two members appointed by the minority leader of the senate; and five members of the house of representatives, three members appointed by the speaker of the house, and two members appointed by the minority leader of the house of representatives. (b) Appointed legislative members serve at the pleasure of the appointing authority and shall continue to serve until their successors are appointed. (c) The first meeting of the committee shall be convened by the chair of the Legislative Coordinating Commission. Members shall elect a chair at the first meeting. The chair must convene at least one meeting annually, and may convene other meetings as deemed necessary. Subd. 3.  [Repealed, 2015 c 71 art 12 s 9] Subd. 4. Review of costs. The board shall submit for review the annual budget of MNsure for the next fiscal year by March 15 of each year, beginning March 15, 2014. Subd. 5. Review of Minnesota eligibility system funding and expenditures. The committee shall review quarterly reports submitted by the Minnesota Eligibility System Executive Steering Committee under section 62V.055, subdivision 3, regarding Minnesota eligibility system funding and expenditures. History:  2013 c 9 s 13; 2013 c 108 art 1 s 67; 2016 c 163 art 4 s 3
MN Stat § 62W.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.01 — Citation.

62W.01 CITATION. This chapter may be cited as the "Minnesota Pharmacy Benefit Manager Licensure and Regulation Act." History:   2019 c 39 s 1
MN Stat § 62W.04 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.04 — Pharmacy Benefit Manager General Business Practices.

62W.04 PHARMACY BENEFIT MANAGER GENERAL BUSINESS PRACTICES. (a) A pharmacy benefit manager must exercise good faith and fair dealing in the performance of its contractual duties. A provision in a contract between a pharmacy benefit manager and a health carrier or a network pharmacy that attempts to waive or limit this obligation is void. (b) A pharmacy benefit manager must notify a health carrier in writing of any activity, policy, or practice of the pharmacy benefit manager that directly or indirectly presents a conflict of interest with the duties imposed in this section. History:   2019 c 39 s 4
MN Stat § 62W.05 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.05 — Pharmacy Benefit Manager Network Adequacy.

62W.05 PHARMACY BENEFIT MANAGER NETWORK ADEQUACY. Subdivision 1. Requirements. (a) A pharmacy benefit manager must provide an adequate and accessible pharmacy network for the provision of prescription drugs that meet the relevant requirements in section 62K.10. Mail order pharmacies must not be included in the calculations of determining the adequacy of the pharmacy benefit manager's pharmacy network under section 62K.10. (b) A pharmacy benefit manager must submit to the commissioner a pharmacy network adequacy report describing the pharmacy network and pharmacy accessibility in this state, with the pharmacy benefit manager's license application and renewal, in a manner prescribed by the commissioner. Subd. 2. Network adequacy waiver. A pharmacy benefit manager may apply for a waiver from the commissioner of health if the pharmacy benefit manager is unable to meet the network adequacy requirements under subdivision 1. A waiver application must be submitted to the commissioner of health on a form prescribed by the commissioner of health and must: (1) demonstrate with specific data why the pharmacy benefit manager is not able to meet the requirements; and (2) include information as to the steps that were and will be taken to address network adequacy. If a waiver is granted by the commissioner of health, the waiver shall automatically expire after three years. If a renewal of the waiver is sought, the commissioner of health shall consider steps that the pharmacy benefit manager has taken over the past three-year period to address network adequacy. Subd. 3. Accreditation standards. A pharmacy benefit manager must not require pharmacy accreditation standards or recertification requirements to participate in a network that are inconsistent with, more stringent than, or in addition to federal and state requirements for licensure as a pharmacy in this state unless authorized under this chapter. History:   2019 c 39 s 5
MN Stat § 62W.075 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.075 — Therapeutic Alternative Prescription Drug.

62W.075 THERAPEUTIC ALTERNATIVE PRESCRIPTION DRUG. A pharmacy benefit manager or health carrier must not require, or demonstrate a preference for, a pharmacy to dispense a therapeutically equivalent or therapeutically alternative drug that costs the enrollee more out-of-pocket than the prescribed drug, unless the substitution is made for medical reasons that benefit the patient. Before a substitution is made under this section, the pharmacy must obtain approval from the prescribing practitioner and must inform the enrollee of the reason for the substitution. History:   2019 c 39 s 8
MN Stat § 62W.076 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.076 — Specialty Pharmacy.

62W.076 SPECIALTY PHARMACY. A pharmacy benefit manager that contracts with a specialty pharmacy must disclose to an enrollee, upon request, the enrollee's out-of-pocket costs at the specialty pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a network retail pharmacy that is identified by the enrollee that is within the enrollee's health plan network. History:   2019 c 39 s 9
MN Stat § 62W.077 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.077 — Preferred Network.

62W.077 PREFERRED NETWORK. A pharmacy benefit manager that uses a preferred network of pharmacies must disclose to an enrollee upon request the enrollee's out-of-pocket cost at the preferred pharmacy for the prescription drug referenced by the enrollee and the enrollee's out-of-pocket cost at a nonpreferred pharmacy identified by the enrollee that is within the enrollee's health plan network. History:   2019 c 39 s 10
MN Stat § 62W.08 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.08 — Maximum Allowable Cost Pricing.

62W.08 MAXIMUM ALLOWABLE COST PRICING. (a) With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefits manager must: (1) provide to the pharmacy, at the beginning of each contract and contract renewal, the sources utilized to determine the maximum allowable cost pricing of the pharmacy benefit manager; (2) update any maximum allowable cost price list at least every seven business days, noting any price changes from the previous list, and provide a means by which network pharmacies may promptly review current prices in an electronic, print, or telephonic format within one business day at no cost to the pharmacy; (3) maintain a procedure to eliminate products from the list of drugs subject to maximum allowable cost pricing in a timely manner in order to remain consistent with changes in the marketplace; (4) ensure that the maximum allowable cost prices are not set below sources utilized by the pharmacy benefits manager; and (5) upon request of a network pharmacy, disclose the sources utilized for setting maximum allowable cost price rates on each maximum allowable cost price list included under the contract and identify each maximum allowable cost price list that applies to the network pharmacy. A pharmacy benefit manager must make the list of the maximum allowable costs available to a contracted pharmacy in a format that is readily accessible and usable to the network pharmacy. (b) A pharmacy benefit manager must not place a prescription drug on a maximum allowable cost list unless the drug is available for purchase by pharmacies in this state from a national or regional drug wholesaler and is not obsolete. (c) Each contract between a pharmacy benefit manager and a pharmacy must include a process to appeal, investigate, and resolve disputes regarding maximum allowable cost pricing that includes: (1) a 15-business-day limit on the right to appeal following the initial claim; (2) a requirement that the appeal be investigated and resolved within seven business days after the appeal is received; and (3) a requirement that a pharmacy benefit manager provide a reason for any appeal denial and identify the national drug code of a drug that may be purchased by the pharmacy at a price at or below the maximum allowable cost price as determined by the pharmacy benefit manager. (d) If an appeal is upheld, the pharmacy benefit manager must make an adjustment to the maximum allowable cost price no later than one business day after the date of determination. The pharmacy benefit manager must make the price adjustment applicable to all similarly situated network pharmacy providers as defined by the plan sponsor. History:   2019 c 39 s 11
MN Stat § 62W.10 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.10 — Synchronization.

62W.10 SYNCHRONIZATION. (a) For purposes of this section, "synchronization" means the coordination of prescription drug refills for a patient taking two or more medications for one or more chronic conditions, to allow the patient's medications to be refilled on the same schedule for a given period of time. (b) A contract between a pharmacy benefit manager and a pharmacy must allow for synchronization of prescription drug refills for a patient on at least one occasion per year, if the following criteria are met: (1) the prescription drugs are covered under the patient's health plan or have been approved by a formulary exceptions process; (2) the prescription drugs are maintenance medications as defined by the health plan and have one or more refills available at the time of synchronization; (3) the prescription drugs are not Schedule II, III, or IV controlled substances; (4) the patient meets all utilization management criteria relevant to the prescription drug at the time of synchronization; (5) the prescription drugs are of a formulation that can be safely split into short-fill periods to achieve synchronization; and (6) the prescription drugs do not have special handling or sourcing needs that require a single, designated pharmacy to fill or refill the prescription. (c) When necessary to permit synchronization, the pharmacy benefit manager must apply a prorated, daily patient cost-sharing rate to any prescription drug dispensed by a pharmacy under this section. The dispensing fee must not be prorated, and all dispensing fees shall be based on the number of prescriptions filled or refilled. (d) Synchronization may be requested by the patient or by the patient's parent or legal guardian if the patient is under the age of 18 or is incapacitated as defined in section 524.5-102, or by the patient's health care agent as defined in chapter 145C. History:   2019 c 39 s 13
MN Stat § 62W.11 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.11 — Gag Clause Prohibition.

62W.11 GAG CLAUSE PROHIBITION. (a) No contract between a pharmacy benefit manager or health carrier and a pharmacy or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing to an enrollee any health care information that the pharmacy or pharmacist deems appropriate regarding the nature of treatment; the risks or alternatives; the availability of alternative therapies, consultations, or tests; the decision of utilization reviewers or similar persons to authorize or deny services; the process that is used to authorize or deny health care services or benefits; or information on financial incentives and structures used by the health carrier or pharmacy benefit manager. (b) A pharmacy or pharmacist must provide to an enrollee information regarding the enrollee's total cost for each prescription drug dispensed where part or all of the cost of the prescription is being paid or reimbursed by the employer-sponsored plan or by a health carrier or pharmacy benefit manager, in accordance with section 151.214, subdivision 1. (c) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or pharmacy from discussing information regarding the total cost for pharmacy services for a prescription drug, including the patient's co-payment amount, the pharmacy's own usual and customary price for the prescription drug, the pharmacy's acquisition cost for the prescription drug, and the amount the pharmacy is being reimbursed by the pharmacy benefit manager or health carrier for the prescription drug. (d) A pharmacy benefit manager must not prohibit a pharmacist or pharmacy from discussing with a health carrier the amount the pharmacy is being paid or reimbursed for a prescription drug by the pharmacy benefit manager or the pharmacy's acquisition cost for a prescription drug. (e) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or pharmacy from discussing the availability of any therapeutically equivalent alternative prescription drugs or alternative methods for purchasing the prescription drug, including but not limited to paying out-of-pocket the pharmacy's usual and customary price when that amount is less expensive to the enrollee than the amount the enrollee is required to pay for the prescription drug under the enrollee's health plan. History:  2019 c 39 s 14; 2021 c 30 art 5 s 1
MN Stat § 62W.12 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.12 — Point Of Sale.

62W.12 POINT OF SALE. No pharmacy benefit manager or health carrier shall require an enrollee to make a payment at the point of sale for a covered prescription drug in an amount greater than the lesser of: (1) the applicable co-payment for the prescription drug; (2) the allowable claim amount for the prescription drug; or (3) the amount an enrollee would pay for the prescription drug if the enrollee purchased the prescription drug without using a health plan or any other source of prescription drug benefits or discounts. History:   2019 c 39 s 15
MN Stat § 62W.13 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62W — Minnesota Pharmacy Benefit Manager|Section 62W.13 — Retroactive Adjustments.

62W.13 RETROACTIVE ADJUSTMENTS. No pharmacy benefit manager shall retroactively adjust a claim for reimbursement submitted by a pharmacy for a prescription drug, unless the adjustment is a result of a: (1) pharmacy audit conducted in accordance with section 62W.09; or (2) technical billing error. History:   2019 c 39 s 16