certain documentation or billing practices, so long as they are not unduly burdensome or unreasonable. Subdivision 2 prohibits a health carrier from denying coverage of a service solely because the service was delivered via telemedicine and was not provided through in-person contact between the licensed health care provider and patient. Identical Subd. 2. Parity between telemedicine and in-person services. Prohibits a health carrier from excluding a service for coverage solely because the service is provided via telemedicine and not provided through consultation or contact. Subdivision 3 requires the health carrier to reimburse the distant site provider for services delivered via telemedicine on the same basis and at the same rate as would apply to the services, consultation, or contacts if provided in person. Permits the health carrier to require a deductible, co-payment, or coinsurance for services provided by telemedicine so long as the deductible, or coinsurance does not exceed the deductible, co-payment, or coinsurance applicable if the service is provided through in-person contact. Senate paragraph (a) reimburses “on the same basis and at the same rate as the health carrier” would apply to an in person visit. House paragraph (a) reimburses “commensurate with the costs of delivering health care services though telemedicine” and has the distant site provider as the responsible party for reimbursing fees to the originating site. Subd. 3. Reimbursement for telemedicine services. (a) Requires a health carrier to reimburse a distant site provider for covered services delivered via telemedicine commensurate with the cost of delivering health care services through telemedicine. States that the distant site provider is responsible for reimbursing any fees to the originating site. (b) States that it is not a violation of this subdivision for a health carrier to include a deductible, co-payment, or coinsurance requirement for a health care service provided via telemedicine, so long as it is not in addition to and does not exceed any payment that would applicable for in-person contact. Subdivision 4 requires a health carrier to make a facility fee payment to the originating site health care provider for the delivery of telemedicine to the enrollee. The facility fee payment to the originating site provider is in addition to the reimbursement to the distant site Senate only provision
Section 11 (62M.02, subd. 12) modifies the definition of health benefit plan to include a health plan that provides coverage of prescription drugs. Senate only provision Section 12 (62M.02, subd. 14) modifies the definition of “outpatient services” to include prescription drugs. Senate only provision Section 13 (62M.02, subd. 14b) adds a definition for “prescription.” Senate only provision Section 14 (62M.02, subd. 14c) adds a definition for “prescription drug order.” Senate only provision Section 15 (62M.02, subd. 15) modifies the definition of “prior authorization” to include preadmission review, pretreatment review, pharmaceutical utilization management procedures, utilization, and case management and any utilization review organization’s requirement that an enrollee or provider notify the utilization review organization prior to providing a service. Senate only provision Section 16 (62M.01, subd. 17) modifies the definition of “provider” to include a licensed pharmacist. Senate only provision Section 17 (62M.01, subd. 18a) adds a definition for “quantity limit.” Senate only provision Section 18 (62M.01, subd. 19a) adds a definition for “step therapy.” Senate only provision Section 19 (62M.05, subd. 3a) modifies the time in which an initial determination on requests for utilization review must be communicated to the provider and enrollee from ten business days to five business days of the request. Senate only provision
Subd. 3. Paragraph (a), specifies that once a formulary has been established a health plan company, may at any time during an enrollee’s contract year, expand its formulary by adding drugs to the formulary; reduce the copayments or coinsurance; or move a drug to a benefit category that reduces the enrollee’s cost. Paragraph (b) states that a health plan company may remove a brand name drug from its formulary or place a brand name drug in a benefit category that increases an enrollee’s cost only if an A-rated generic or multisource brand name equivalent is added to the formulary at a lower cost to the enrollee and upon 60 notice to prescribers, pharmacists, and affected enrollees. Paragraph (c) prohibits a health plan company from removing drugs from its formulary or moving drugs to a benefit category that increases an enrollee’s cost during the enrollee’s contract year. This prohibition does not apply if the change is associated with the drug being deemed unsafe by the FDA or it has been withdrawn by the FDA or the manufacturer, or an independent source has issued drug specific warnings or recommended changes in drug usage. Paragraph (d) prohibits managed care plans and county-based purchasing plans from removing drugs from its formulary or moving a drug to a benefit category that increases an enrollee’s cost more than annually unless an A-rated generic or multisource brand name equivalent is added to formulary. Senate only provision