reglab/statecodes huggingface dataset:
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.23 — Technical Assistance; Loans.

62N.23 TECHNICAL ASSISTANCE; LOANS.
(a) The commissioner shall provide technical assistance to parties interested in establishing or operating a community integrated service network. This shall be known as the community integrated service network technical assistance program (CISNTAP).
The technical assistance program shall offer seminars on the establishment and operation of community integrated service networks in all regions of Minnesota. The commissioner shall advertise these seminars in local and regional newspapers, and attendance at these seminars shall be free.
The commissioner shall write a guide to establishing and operating a community integrated service network. The guide must provide basic instructions for parties wishing to establish a community integrated service network. The guide must be provided free of charge to interested parties. The commissioner shall update this guide when appropriate.
The commissioner shall establish a toll-free telephone line that interested parties may call to obtain assistance in establishing or operating a community integrated service network.
(b) The commissioner shall grant loans for organizational and start-up expenses to entities forming community integrated service networks, or to networks less than one year old, to the extent of any appropriation for that purpose. The commissioner shall allocate the available funds among applicants based upon the following criteria, as evaluated by the commissioner within the commissioner's discretion:
(1) the applicant's need for the loan;
(2) the likelihood that the loan will foster the formation or growth of a network; and
(3) the likelihood of repayment.
The commissioner shall determine any necessary application deadlines and forms.
History:
1993 c 345 art 1 s 19; 1994 c 625 art 12 s 1; 1997 c 187 art 2 s 2; 1997 c 225 art 2 s 33
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.26 — Shared Services Cooperative.

62N.26 SHARED SERVICES COOPERATIVE.
The commissioner of health shall establish, or assist in establishing, a shared services cooperative organized under chapter 308A to make available administrative and legal services, technical assistance, provider contracting and billing services, and other services to those community integrated service networks that choose to participate in the cooperative. The commissioner shall provide, to the extent funds are appropriated, start-up loans sufficient to maintain the shared services cooperative until its operations can be maintained by fees and contributions. The cooperative must not be staffed, administered, or supervised by the commissioner of health. The cooperative shall make use of existing resources that are already available in the community, to the extent possible.
History:
1994 c 625 art 1 s 7; 1997 c 225 art 2 s 35
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.31 — Standards For Accredited Capitated Provider Accreditation.

62N.31 STANDARDS FOR ACCREDITED CAPITATED PROVIDER ACCREDITATION.
Subdivision 1.
General.
Each health care providing entity seeking initial accreditation as an accredited capitated provider shall submit to the commissioner of health sufficient information to establish that the applicant has operational capacity, facilities, personnel, and financial capability to provide the contracted covered services to the enrollees of the network for which it seeks accreditation (1) on an ongoing basis; and (2) for a period of 120 days following the insolvency of the network without receiving payment from the network. Accreditation shall continue until abandoned by the accredited capitated provider or revoked by the commissioner in accordance with subdivision 4. The applicant may establish financial capability by demonstrating that the provider amount at risk can be covered by or through any of allocated or restricted funds, a letter of credit, the taxing authority of the applicant or governmental sponsor of the applicant, an unrestricted fund balance at least two times the provider amount at risk, reinsurance, either purchased directly by the applicant or by the community network to which it will be accredited, or any other method accepted by the commissioner. Accreditation of a health care providing entity shall not in itself limit the right of the accredited capitated provider to seek payment of unpaid capitated amounts from a community network, whether the community network is solvent or insolvent; provided that, if the community network is subject to any liquidation, rehabilitation, or conservation proceedings, the accredited capitated provider shall have the status accorded creditors under section 60B.44, subdivision 10.
Subd. 2.
Annual reporting period.
Each accredited capitated provider shall submit to the commissioner annually, no later than April 15, the following information for each network to which it is accredited: the provider amount at risk for that year, the number of enrollees for the network, both for the prior year and estimated for the current year, any material change in the provider's operational or financial capacity since its last report, and any other information reasonably requested by the commissioner.
Subd. 3.
Additional reporting.
Each accredited capitated provider shall provide the commissioner with 60 days' advance written notice of termination of the accredited capitated provider relationship with a network.
Subd. 4.
Revocation of accreditation.
The commissioner may revoke the accreditation of an accredited capitated provider if the accredited capitated provider's ongoing operational or financial capabilities fail to meet the requirements of this section. The revocation shall be handled in the same fashion as placing a health maintenance organization under administrative supervision.
History:
1994 c 625 art 1 s 11
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.32 — Deposit Requirement.

62N.32 DEPOSIT REQUIREMENT.
A community network must satisfy the deposit requirement provided in section 62D.041. The deposit counts as an admitted asset and as part of the required net worth. The deposit requirement cannot be reduced by the alternative means that may be used to reduce the net worth requirement, other than through the use of a guaranteeing organization.
History:
1994 c 625 art 1 s 12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.33 — Coverage For Enrollees Of Insolvent Networks.

62N.33 COVERAGE FOR ENROLLEES OF INSOLVENT NETWORKS.
In the event of a community network insolvency, the commissioner shall determine whether one or more community networks or health plan companies are willing and able to provide replacement coverage to all of the failed community network's enrollees, and if so, the commissioner shall facilitate the provision of the replacement coverage. If such replacement coverage is not available, the commissioner shall randomly assign enrollees of the insolvent community network to other community networks and health plan companies in the service area, in proportion to their market share, for the remaining terms of the enrollees' contracts with the insolvent network. The other community networks and health plan companies must accept the allocated enrollees under their policy or contract most similar to the enrollees' contracts with the insolvent community network. The allocation must keep groups together. Enrollees with special continuity of care needs may, in the commissioner's discretion, be given a choice of replacement coverage rather than random assignment. Individuals and groups that are assigned randomly may choose a different community network or health plan company when their contracts expire, on the same basis as any other individual or group. The replacement health plan company must comply with any guaranteed renewal or other renewal provisions of the prior coverage, including but not limited to, provisions regarding preexisting conditions and health conditions that developed during prior coverage.
History:
1994 c 625 art 1 s 13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.35 — Border Issues.

62N.35 BORDER ISSUES.
To the extent feasible and appropriate, community networks that also operate under the health maintenance organization or similar prepaid health care law of another state must be licensed and regulated by this state in a manner that avoids unnecessary duplication and expense for the community network. The commissioner shall communicate with regulatory authorities in neighboring states to explore the feasibility of cooperative approaches to streamline regulation of border community networks, such as joint financial audits, and shall report to the legislature on any changes to Minnesota law that may be needed to implement appropriate collaborative approaches to regulation.
History:
1994 c 625 art 1 s 15
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62N — Community Integrated Service Network › Section 62N.40 — Chemical Dependency Services.

62N.40 CHEMICAL DEPENDENCY SERVICES.
Each community integrated service network regulated under this chapter must ensure that chemically dependent individuals have access to cost-effective treatment options that address the specific needs of individuals. These include, but are not limited to, the need for: treatment that takes into account severity of illness and comorbidities; provision of a continuum of care, including treatment and rehabilitation programs licensed under chapter 245G; the safety of the individual's domestic and community environment; gender appropriate and culturally appropriate programs; and access to appropriate social services.
History:
1995 c 234 art 1 s 28; 1997 c 225 art 2 s 36; 2016 c 158 art 1 s 20; 2018 c 182 art 2 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.02 — Applicability Of Chapter.

62Q.02 APPLICABILITY OF CHAPTER.
(a) This chapter applies only to health plans, as defined in section 62Q.01, and not to other types of insurance issued or renewed by health plan companies, unless otherwise specified.
(b) This chapter applies to a health plan company only with respect to health plans, as defined in section 62Q.01, issued or renewed by the health plan company, unless otherwise specified.
(c) If a health plan company issues or renews health plans in other states, this chapter applies only to health plans issued or renewed in this state for Minnesota residents, or to cover a resident of the state, unless otherwise specified.
History:
1995 c 234 art 2 s 7
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.021 — Federal Act; Compliance Required.

62Q.021 FEDERAL ACT; COMPLIANCE REQUIRED.
Subdivision 1.
Compliance with 1996 federal law.
Each health plan company shall comply with the federal Health Insurance Portability and Accountability Act of 1996, including any federal regulations adopted under that act, to the extent that it imposes a requirement that applies in this state and that is not also required by the laws of this state. This section does not require compliance with any provision of the federal act prior to the effective date provided for that provision in the federal act. The commissioner shall enforce this subdivision.
Subd. 2.
Compliance with 2010 federal law.
Each health plan company shall comply with the Affordable Care Act to the extent that it imposes a requirement that applies in this state but is not required under the laws of this state. This section does not require compliance with any provision of the Affordable Care Act before the effective date provided for that provision in the Affordable Care Act. The commissioner shall enforce this subdivision.
Subd. 3.
Compliance with 2021 federal law.
Each health plan company, health provider, and health facility shall comply with the No Surprises Act, including any federal regulations adopted under the act, to the extent that the act imposes requirements that apply in this state but are not required under the laws of this state. This subdivision does not require compliance with any provision of the No Surprises Act before the effective date provided for that provision in the No Surprises Act. The commissioner shall enforce this subdivision.
History:
1997 c 175 art 4 s 2; 2013 c 84 art 1 s 68; 2023 c 70 art 2 s 24
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.025 — High Deductible Health Plans.

62Q.025 HIGH DEDUCTIBLE HEALTH PLANS.
Subdivision 1.
Qualified plan.
A high deductible health plan shall be deemed a qualified plan under sections 62E.06 and 62E.12. The plan must meet all other requirements of state law except those that are inconsistent with a high deductible health plan as defined in sections 220 and 223 of the Internal Revenue Code and supporting regulations.
Subd. 2.
Authorization.
Notwithstanding any other law of this state, any health plan company defined in section 62Q.01, subdivision 4, is permitted to offer high deductible health plans.
History:
2004 c 268 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.096 — Credentialing Of Providers.

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 mental health clinic certified under section 245I.20;
(3) is designated an essential community provider under section 62Q.19; and
(4) is under contract with the health plan company to provide mental health services, the health plan company must continue to credential at least the same number of providers from that entity, as long as those providers meet the health plan company's credentialing standards.
(b) In order to ensure timely access by patients to mental health services, between July 1, 2023, and June 30, 2025, a health plan company must credential and enter into a contract for mental health services with any provider of mental health services that:
(1) meets the health plan company's credential requirements. For purposes of credentialing under this paragraph, a health plan company may waive credentialing requirements that are not directly related to quality of care in order to ensure patient access to providers from underserved communities or to providers in rural areas;
(2) seeks to receive a credential from the health plan company;
(3) agrees to the health plan company's contract terms. The contract shall include payment rates that are usual and customary for the services provided;
(4) is accepting new patients; and
(5) is not already under a contract with the health plan company under a separate tax identification number or, if already under a contract with the health plan company, has provided notice to the health plan company of termination of the existing contract.
(c) A health plan company shall not refuse to credential these providers on the grounds that their provider network has:
(1) a sufficient number of providers of that type, including but not limited to the provider types identified in paragraph (a); or
(2) a sufficient number of providers of mental health services in the aggregate.
History:
1998 c 407 art 8 s 4; 2021 c 30 art 17 s 3; 2023 c 57 art 2 s 40
NOTE:
The amendment to this section by Laws 2021, chapter 30, article 17, section 3, is effective upon federal approval. The commissioner of human services shall notify the revisor of statutes when federal approval is obtained. Laws 2021, chapter 30, article 17, section 114.
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.097 — Requirements For Timely Provider Credentialing.

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 by a health care provider to a health plan company that is complete, is in the format required by the health plan company, and includes all information and substantiation required by the health plan company and does not require evaluation of any identified potential quality or safety concern.
(c) "Provider credentialing" means the process undertaken by a health plan company to evaluate and approve a health care provider's education, training, residency, licenses, certifications, and history of significant quality or safety concerns in order to approve the health care provider to provide health care services to patients at a clinic or facility.
Subd. 2.
Time limit for credentialing determination.
A health plan company that receives an application for provider credentialing must:
(1) if the application is determined to be a clean application for provider credentialing and if the health care provider submitting the application or the clinic or facility at which the health care provider provides services requests the information, affirm that the health care provider's application is a clean application and notify the health care provider or clinic or facility of the date by which the health plan company will make a determination on the health care provider's application;
(2) if the application is determined not to be a clean application, inform the health care provider of the application's deficiencies or missing information or substantiation within three business days after the health plan company determines the application is not a clean application; and
(3) make a determination on the health care provider's clean application within 45 days after receiving the clean application unless the health plan company identifies a substantive quality or safety concern in the course of provider credentialing that requires further investigation. Upon notice to the health care provider, clinic, or facility, the health plan company is allowed 30 additional days to investigate any quality or safety concerns.
History:
2021 c 30 art 6 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.101 — Evaluation Of Provider Performance.

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 upon practice experience of the provider group; and
(2) disclose the baseline to the health care provider in writing and prior to the beginning of the time period used for the evaluation.
History:
2007 c 147 art 15 s 10
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.1055 — Chemical Dependency.

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
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.106 — Dispute Resolution By Commissioner.

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 chapter 45, 60A, or 62D.
(b) In investigating a complaint filed against a health maintenance organization regarding a vulnerable adult, upon request, the commissioner of health must interview at least one family member of the complainant or the subject of the complaint. If the complainant or the subject of the complaint does not want any family members to be interviewed, this information will be included in the investigative file.
History:
1995 c 234 art 2 s 23; 1997 c 225 art 2 s 41; 1999 c 239 s 32; 2013 c 43 s 2
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.107 — Prohibited Provision; Judicial Review.

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 decision made by a health plan company with respect to an enrollee. This section prohibits limiting court review to a determination of whether the health plan company's decision is arbitrary and capricious, an abuse of discretion, or any other standard less favorable to the enrollee than a preponderance of the evidence.
History:
1998 c 407 art 2 s 21
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.12 — Denial Of Access.

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 s 20
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.121 — Licensure Of Medical Directors.

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 amount assessed by the Minnesota Comprehensive Health Association.
(b) For purposes of this section, "medical director" means a physician employed by a health plan company who has direct decision-making authority, based upon medical training and knowledge, regarding the health plan company's medical protocols, medical policies, or coverage of treatment of a particular enrollee, regardless of the physician's title.
(c) This section applies only to medical directors who make recommendations or decisions that involve or affect enrollees who live in this state.
(d) Each health plan company that is subject to this section shall provide the commissioner with the names and licensure information of its medical directors and shall provide updates no later than 30 days after any changes.
History:
1Sp2001 c 9 art 16 s 6; 2002 c 379 art 1 s 113
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.135 — Contracting For Chemical Dependency Services.

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. The commissioner of human services shall make data on chemical dependency services and outcomes collected through this program available to health plan companies.
History:
1994 c 625 art 2 s 21
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.137 — Chemical Dependency Treatment; Coverage.

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 commissioner of corrections following a conviction for a first-degree driving while impaired offense under section 169A.24 if: (1) a court of competent jurisdiction makes a preliminary determination based on a chemical use assessment conducted under section 169A.70 that treatment may be appropriate and includes this determination as part of the sentencing order; and (2) the Department of Corrections makes a determination based on a chemical assessment conducted while the individual is in the custody of the department that treatment is appropriate. Treatment provided by the Department of Corrections that meets the requirements of this section shall not be subject to a separate medical necessity determination under the health plan company's utilization review procedures.
(b) The health plan company must be given a copy of the court's preliminary determination and supporting documents and the assessment conducted by the Department of Corrections.
(c) Payment rates for treatment provided by the Department of Corrections shall not exceed the lowest rate for outpatient chemical dependency treatment paid by the health plan company to a participating provider of the health plan company.
(d) For purposes of this section, chemical dependency treatment means all covered services that are intended to treat chemical dependency and that are covered by the enrollee's health plan or by law.
History:
1Sp2001 c 9 art 19 s 1; 2002 c 379 art 1 s 113
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.14 — Restrictions On Enrollee Services.

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, provided that this clause does not refer to abortion services;
(2) the diagnosis of infertility;
(3) the testing and treatment of a sexually transmitted disease; and
(4) the testing for AIDS or other HIV-related conditions.
History:
1994 c 625 art 2 s 22
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.16 — Midmonth Termination Prohibited.

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 the month in which coverage was terminated.
History:
1994 c 625 art 2 s 23
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.165 — Universal Coverage.

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 services;
(2) every Minnesotan is able to obtain affordable health coverage which pays for the full range of services, including preventive and primary care; and
(3) every Minnesotan pays into the health care system according to that person's ability.
Subd. 2.
Goal.
It is the goal of the state to make continuous progress toward reducing the number of Minnesotans who do not have health coverage so that by January 1, 2011, all Minnesota residents have access to affordable health care. The goal will be achieved by improving access to private health coverage through insurance reforms and market reforms, by making health coverage more affordable for low-income Minnesotans through purchasing pools and state subsidies, and by reducing the cost of health coverage through cost containment programs and methods of ensuring that all Minnesotans are paying into the system according to their ability.
Subd. 3.
[Repealed, 1997 c 225 art 2 s 63]
History:
1994 c 625 art 6 s 1; 1995 c 234 art 4 s 1; 2007 c 147 art 15 s 11,12
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.181 — Written Certification Of Coverage.

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 and only to the extent that the certification of coverage is required under federal law. The commissioner shall enforce this section.
History:
1997 c 175 art 4 s 3
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.1841 — Prohibition On Use Of Step Therapy For Metastatic Cancer.

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 provided by a county-based purchasing plan participating in a public program under chapter 256B or 256L or an integrated health partnership under section 256B.0755.
(c) "Stage four advanced metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body.
(d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.
Subd. 2.
Prohibition on use of step therapy protocols.
A health plan that provides coverage for the treatment of stage four advanced metastatic cancer or associated conditions must not limit or exclude coverage for a drug approved by the United States Food and Drug Administration that is on the health plan's prescription drug formulary by mandating that an enrollee with stage four advanced metastatic cancer or associated conditions follow a step therapy protocol if the use of the approved drug is consistent with:
(1) a United States Food and Drug Administration-approved indication; and
(2) a clinical practice guideline published by the National Comprehensive Care Network.
History:
1Sp2019 c 9 art 8 s 13
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.185 — Guaranteed Renewability; Large Employer Group.

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, subdivision 1.
(b) This section does not require renewal if:
(1) the large employer has failed to pay premiums or contributions as required under the terms of the health benefit plan, or the health plan company has not received timely premium payments unless the late payments were received within a grace period provided under state law;
(2) the large employer has performed an act or practice that constitutes fraud or misrepresentation of material fact under the terms of the health benefit plan;
(3) the large employer has failed to comply with a material plan provision relating to employer contribution or group participation rules not prohibited by state law;
(4) the health plan company is ceasing to offer coverage in the large employer market in this state in compliance with United States Code, title 42, section 300gg-12(c), and applicable state law;
(5) in the case of a health maintenance organization, there is no longer any enrollee in the large employer's health benefit plan who lives, resides, or works in the approved service area; or
(6) in the case of a health benefit plan made available to large employers only through one or more bona fide associations, the membership of the large employer in the association ceases, but only if such coverage is terminated uniformly without regard to any health-related factor relating to any covered individual.
(c) This section does not prohibit a health plan company from modifying the premium rate or from modifying the coverage for purposes of renewal.
(d) This section does not require renewal of the coverage of individual enrollees under the health benefit plan if the individual enrollee has performed an act or practice that constitutes fraud or misrepresentation of material fact under the terms of the health benefit plan.
History:
1997 c 175 art 3 s 3; 1999 c 177 s 57
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.186 — Prohibition On Rescissions Of Health Plans.

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 coverage under a health plan if:
(i) the cancellation or discontinuance of coverage has only a prospective effect; or
(ii) the cancellation or discontinuance of coverage is effective retroactively to the extent it is attributable to a failure to timely pay required premiums or contributions toward the cost of coverage; or
(2) when the health plan covers only active employees and, if applicable, dependents and those covered under continuation coverage provisions, the employee pays no premiums for coverage after termination of employment and the cancellation or discontinuance of coverage is effective retroactively back to the date of termination of employment due to a delay in administrative record keeping.
Subd. 2.
Prohibition on rescissions.
(a) A health plan company shall not rescind coverage under a health plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the health plan, unless:
(1) the individual, or a person seeking coverage on behalf of the individual, performs an act, practice, or omission that constitutes fraud; or
(2) the individual makes an intentional misrepresentation or omission of material fact, as prohibited by the terms of the health plan.
For purposes of this section, a person seeking coverage on behalf of an individual does not include an insurance producer or employee or authorized representative of the health carrier.
(b) This section does not apply to any benefits classified as excepted benefits under United States Code, title 42, section 300gg-91(c), or regulations enacted thereunder from time to time.
Subd. 3.
Notice required.
A health plan company shall provide at least 30 days' advance written notice to each individual who would be affected by the proposed rescission of coverage before coverage under the health plan may be terminated retroactively.
Subd. 4.
Compliance with other restrictions on rescissions.
Nothing in this section allows rescission if rescission would otherwise be prohibited under section 62A.04, subdivision 2, clause (2).
History:
2013 c 84 art 1 s 71; 2014 c 275 art 1 s 8
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.188 — Flexible Benefits Plans.

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 employees.
Subd. 2.
Flexible benefits plan.
Notwithstanding any provision of this chapter, chapter 363A, or any other law to the contrary, a health plan company may offer, sell, issue, and renew a health plan that is a flexible benefits plan under this section if the following requirements are satisfied:
(1) the health plan must be offered in compliance with the laws of this state, except as otherwise permitted in this section;
(2) the health plan must be designed to enable covered persons to better manage costs and coverage options through the use of co-pays, deductibles, and other cost-sharing arrangements;
(3) the health plan may modify or exclude any or all coverages of benefits that would otherwise be required by law, except for maternity benefits and other benefits required under federal law;
(4) each health plan and plan's premiums must be approved by the commissioner of health or commerce, whichever is appropriate under section 62Q.01, subdivision 2, but neither commissioner may disapprove a plan on the grounds of a modification or exclusion permitted under clause (3); and
(5) prior to the sale of the health plan, the purchaser must be given a written list of the coverages otherwise required by law that are modified or excluded in the health plan. The list must include a description of each coverage in the list and indicate whether the coverage is modified or excluded. If coverage is modified, the list must describe the modification. The list may, but is not required to, also list any or all coverages otherwise required by law that are included in the health plan and indicate that they are included. The health plan company must require that a copy of this written list be provided, prior to the effective date of the health plan, to each enrollee or employee who is eligible for health coverage under the plan.
Subd. 3.
Employer health plan.
An employer may provide a health plan permitted under this section to its employees, the employees' dependents, and other persons eligible for coverage under the employer's plan, notwithstanding chapter 363A or any other law to the contrary.
History:
2010 c 384 s 24
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.23 — General Services.

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 other coverage required under chapter 62A of newborn infants, dependent children to the limiting age as defined in section 62Q.01, subdivision 2a, disabled dependent children, and adopted children. A health plan company providing dependent coverage shall comply with section 62A.302.
(c) Health plan companies shall comply with the equal access requirements of section 62A.15.
History:
1994 c 625 art 4 s 8; 2005 c 56 s 1; 2013 c 84 art 1 s 72; 2017 c 99 s 1
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.32 — Local Ombudsperson.

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 are not limited to:
(1) mediation or advocacy on behalf of a person accessing the complaint and appeal procedures to ensure that necessary medical services are provided by the health plan company; and
(2) investigation of the quality of services provided to a person and determine the extent to which quality assurance mechanisms are needed or any other system change may be needed.
History:
1994 c 625 art 7 s 2; 1995 c 234 art 8 s 18; 1Sp2011 c 9 art 6 s 14
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.43 — Geographic Access.

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 primary care provider designated by the enrollee that is within the health plan company's clinic or provider network.
Subd. 2.
Access requirement.
Every closed-panel health plan must allow enrollees under the age of 26 years to change their designated clinic or primary care provider at least once per month, as long as the clinic or provider is part of the health plan company's statewide clinic or provider network. A health plan company shall not charge enrollees who choose this option higher premiums or cost sharing than would otherwise apply to enrollees who do not choose this option. A health plan company may require enrollees to provide 15 days' written notice of intent to change their designated clinic or primary care provider.
History:
1995 c 234 art 2 s 27; 2013 c 84 art 1 s 73; 2020 c 115 art 4 s 9,10
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.45 — Coverage For Out-of-area Primary Care.

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 health care providers who are employed by or under contract with another managed care organization. The commissioner shall make recommendations on: (1) whether this out-of-area primary care coverage should be available to students and/or other enrollees without additional premium charges or cost sharing; (2) methods to coordinate the services provided by different managed care organizations; (3) methods to manage the quality of care provided by different managed care organizations and monitor health care outcomes; (4) methods to reimburse managed care organizations for care provided to enrollees of other managed care organizations; and (5) other issues relevant to the design and administration of out-of-area primary care coverage. The commissioner shall present recommendations to the legislature by January 15, 1996.
Subd. 2.
Definition.
For purposes of this section, "managed care organization" means:
(1) a health maintenance organization operating under chapter 62D;
(2) a community integrated service network as defined under section 62N.02, subdivision 4a; or
(3) an insurance company licensed under chapter 60A, nonprofit health service plan corporation operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other health plan company, to the extent that it covers health care services delivered to Minnesota residents through a preferred provider organization or a network of selected providers.
History:
1995 c 234 art 2 s 28; 1997 c 225 art 2 s 44
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.465 — Mental Health Parity And Substance Abuse Accountability Office.

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) section 62Q.47;
(2) the federal Mental Health Parity Act of 1996, Public Law 104-204;
(3) the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Public Law 110-343, division C, sections 511 and 512;
(4) the Affordable Care Act, as defined under section 62A.011, subdivision 1a; and
(5) amendments made to, and federal guidance or regulations issued or adopted under, the acts listed under clauses (2) to (4).
(b) The office may oversee compliance reviews, conduct and lead stakeholder engagement, review consumer and provider complaints, and serve as a resource for ensuring health plan compliance with mental health and substance abuse requirements.
History:
2023 c 57 art 2 s 44
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.471 — Exclusion For Suicide Attempts Prohibited.

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 enrollee.
(b) For purposes of this section, "health plan" has the meaning given in section 62Q.01, subdivision 3, but includes the coverages described in section 62A.011, subdivision 3, clauses (4), (6), and (7) through (10).
History:
1Sp2001 c 9 art 9 s 1; 2002 c 379 art 1 s 113; 2005 c 132 s 16; 2014 c 275 art 1 s 9
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.472 — Screening And Testing For Opioids.

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 ordered by a health care provider and performed by an accredited clinical laboratory. A health plan company is not prohibited from conducting a medical necessity review when screenings or urinalysis testing for an enrollee exceeds 24 tests in any 12-month period.
(b) This section does not apply to managed care plans or county-based purchasing plans when the plan provides coverage to public health care program enrollees under chapter 256B or 256L.
History:
1Sp2021 c 4 art 3 s 16
2023 Minnesota Statutes › Chapters 59A - 79A — Insurance › Chapter 62Q — Health Plan Companies › Section 62Q.48 — Cost-sharing In Prescription Insulin Drugs.

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 meanings given them.
(b) "Cost-sharing" means a deductible payment, co-payment, or coinsurance amount imposed on an enrollee for a covered prescription drug in accordance with the terms and conditions of the enrollee's health plan.
(c) "Legend drug" has the same meaning as in section 151.01, subdivision 17.
(d) "Prescription insulin drug" means a legend drug that contains insulin and is used to treat diabetes.
(e) "Net price" means the health plan company's cost for a prescription insulin drug, including any rebates or discounts received by or accrued directly or indirectly to the health plan company from a drug manufacturer or pharmacy benefit manager.
Subd. 3.
Cost-sharing limits.
(a) A health plan that imposes a cost-sharing requirement on the coverage of a prescription insulin drug shall limit the total amount of cost-sharing that an enrollee is required to pay at point of sale, including deductible payments and the cost-sharing amounts charged once the deductible is met at an amount that does not exceed the net price of the prescription insulin drug.
(b) Nothing in this section shall prevent a health plan company from imposing a cost-sharing requirement that is less than the amount specified in paragraph (a).
History:
1Sp2019 c 9 art 8 s 15