Chapter 62Q — Minnesota Health Plan Contracting Act

15.001 Application of Laws 2005, Chapter 56, Terminology Changes This section directs state agencies to adopt the terminology changes specified in Laws 2005, chapter 56, section 1, but … 62Q.001 This section contains no operative statutory text. The body consists only of a cross-reference pointing to section … 62Q.01 Definitions Defines key terms used in Minnesota's health plan regulation laws. 62Q.02 Applicability of Chapter This section defines the scope of chapter 62Q. The chapter applies only to health plans as defined in section 62Q.01, … 62Q.021 Federal Act; Compliance Required This section requires each health plan company to comply with three federal laws to the extent each imposes a … 62Q.025 High Deductible Health Plans This section deems a high deductible health plan to be a qualified plan under Minnesota Statutes sections 62E.06 and … 62Q.03 Process for Risk Adjustment System This section establishes a risk adjustment system that makes monetary transfers from health plan companies insuring … 62Q.07 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.075 Local Public Accountability and Collaboration Plan This section requires every health maintenance organization to file a plan with the commissioner of health every four … 62Q.09 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.095 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.096 Credentialing of Providers This section requires health plan companies to credential mental health providers. If a plan has credentialed providers … 62Q.097 Requirements for Timely Provider Credentialing This section sets deadlines for how quickly a health plan company must process a provider's credentialing application. A … 62Q.10 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.101 Evaluation of Provider Performance This section sets rules for how a health plan company (or a vendor of risk management services) evaluates a health care … 62Q.105 This section has no operative statutory text. The page contains only a session law reference (1999 c 239 s 43), … 62Q.1055 Chemical Dependency This section requires all health plan companies to use the assessment criteria in section 245G.05 when assessing and … 62Q.106 Dispute Resolution by Commissioner This section lets a complainant submit a complaint to the appropriate commissioner to investigate at any time, and after … 62Q.107 Prohibited Provision; Judicial Review Beginning January 1, 1999, this section prohibits any health plan, including the coverages described in section 62A.011, … 62Q.11 This section has no operative statutory text. The page contains only a session law reference (1999 c 239 s 43), … 62Q.12 Denial of Access This section limits who may deny access to a covered health care service. A health plan company cannot deny access to a … 62Q.121 Licensure of Medical Directors This section requires medical directors at health plan companies to be licensed physicians in Minnesota, except for … 62Q.135 Contracting for Chemical Dependency Services This section restricts which chemical dependency treatment programs a health plan may use. A health plan company cannot … 62Q.137 Chemical Dependency Treatment; Coverage This section requires a health plan that covers chemical dependency treatment to also cover treatment provided by the … 62Q.14 Restrictions on Enrollee Services This section bars a health plan company from restricting where an enrollee may receive certain health services. The … 62Q.145 This section has been repealed and contains no operative statutory text. The body shows only a session law citation … 62Q.16 Midmonth Termination Prohibited When a person's coverage under a health plan (as defined in section 62A.011, subdivision 3) is terminated, the coverage … 62Q.165 Universal Coverage This section states the state's commitment and goal to achieve universal health coverage for all Minnesotans by the year … 62Q.17 Voluntary Purchasing Pools This section lets employers, groups, and individuals voluntarily form purchasing pools to negotiate and buy health plan … 62Q.18 Portability of Coverage This section protects people who keep continuous health coverage when they move between plans. Effective July 1, 1994, a … 62Q.181 Written Certification of Coverage This section requires a health plan company to provide the written certifications of coverage required under federal law … 62Q.184 Step Therapy Override This section governs step therapy protocols, which require a patient to try certain prescription drugs in a set sequence … 62Q.1841 Prohibition on Use of Step Therapy for Metastatic Cancer Addresses prohibition on use of step therapy for metastatic cancer coverage in health plans. 62Q.185 Guaranteed Renewability; Large Employer Group Sets rules for guaranteed renewability; large employer group of health plan coverage. 62Q.186 Prohibition on Rescissions of Health Plans This section bars a health plan company from rescinding coverage, meaning canceling it retroactively, once an individual … 62Q.188 Flexible Benefits Plans Addresses flexible benefits plans under Minnesota health plan regulations. 62Q.19 Essential Community Providers Governs essential community providers requirements for health plans. 62Q.21 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.22 Health Care Services Prepaid Option Addresses health care services prepaid option under Minnesota health plan regulations. 62Q.23 General Services Requires health plan companies to comply with several existing coverage protections. They must follow all continuation … 62Q.25 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.251 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.27 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.29 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.30 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.32 Local Ombudsperson This section allows a county board or a community health service agency to set up an office of ombudsperson to act as a … 62Q.33 Local Government Public Health Functions This section declares that the local government public health functions of community assessment, policy development, and … 62Q.37 Audits Conducted by Independent Organization This section lets the state commissioner accept an audit performed by a nationally recognized independent organization … 62Q.41 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.43 Geographic Access This section applies to closed-panel health plans, meaning plans that require an enrollee to get all or most primary … 62Q.45 Coverage for Out-of-area Primary Care This section directs the commissioner of health to develop methods allowing managed care enrollees to get primary care … 62Q.451 Unrestricted Access to Services for the Diagnosis, Monitoring, and Treatment of Rare Diseases This section bars a health plan company from restricting where an enrollee gets care for diagnosing, monitoring, and … 62Q.46 Preventive Items and Services This section requires a health plan company to cover preventive items and services at a participating provider with no … 62Q.465 Mental Health Parity and Substance Abuse Accountability Office This section creates the Mental Health Parity and Substance Abuse Accountability Office within the Department of … 62Q.47 Alcoholism, Mental Health, and Chemical Dependency Services This section is Minnesota's mental health parity law for health plans that cover alcoholism, mental health, or chemical … 62Q.471 Exclusion for Suicide Attempts Prohibited Addresses exclusion for suicide attempts prohibited under Minnesota health plan regulations. 62Q.472 Screening and Testing for Opioids A health plan company cannot place a lifetime or annual limit on opioid screenings and urinalysis testing for an … 62Q.473 Biomarker Testing A health plan must cover biomarker testing to diagnose, treat, manage, and monitor an illness or disease when the test … 62Q.48 Cost-sharing in Prescription Insulin Drugs This section applies to all health plans issued or renewed to a Minnesota resident and limits what an enrollee pays out … 62Q.481 Cost-sharing for Prescription Drugs and Related Medical Supplies to Treat Chronic Disease A health plan must cap an enrollee's cost-sharing for prescription drugs prescribed to treat a chronic disease at no … 62Q.49 Enrollee Cost Sharing; Negotiated Provider Payments This section applies to health plans that cover care through discounted or negotiated provider charges, employee or … 62Q.50 Prostate Cancer Screening A health plan must cover prostate cancer screening for men 40 years of age or older who are symptomatic or in a … 62Q.51 Point-of-service Option A point-of-service option is a health plan that reimburses a licensed or registered provider for covered services … 62Q.52 Direct Access to Obstetric and Gynecologic Services Health plan companies must allow female enrollees direct access to in-network obstetrics and gynecology providers, … 62Q.521 Postnatal Care A health plan must cover postnatal care, including a comprehensive postnatal visit with a health care provider not more … 62Q.522 Coverage of Contraceptive Methods and Services Addresses coverage of contraceptive methods and services under Minnesota health plan regulations. 62Q.523 Coverage for Prescription Contraceptives; Supply Requirements Health plans that provide prescription coverage must cover prescription contraceptives and dispense up to a 12-month … 62Q.524 Coverage of Abortions and Abortion-related Services Addresses coverage of abortions and abortion-related services under Minnesota health plan regulations. 62Q.525 Coverage for Off-label Drug Use Regulates coverage for off-label drug use in health plans. 62Q.526 Coverage for Participation in Approved Clinical Trials Addresses coverage for participation in approved clinical trials under Minnesota health plan regulations. 62Q.527 Nonformulary Antipsychotic Drugs; Required Coverage Addresses nonformulary antipsychotic drugs; required coverage for health plans in Minnesota. 62Q.528 Drug Coverage in Emergency Situations A health plan that covers prescription drugs must also cover a prescription drug a pharmacist dispenses in an emergency … 62Q.529 Coverage for Drugs Prescribed and Dispensed by Pharmacies A health plan that covers prescription drugs must cover self-administered hormonal contraceptives, nicotine replacement … 62Q.53 Mental Health Coverage; Medically Necessary Care A health plan that covers mental health services cannot define "medically necessary care" (or similar terms) more … 62Q.531 Amino Acid-based Formula Coverage A health plan company must cover amino acid-based elemental formula when it is medically necessary. The statute lists … 62Q.535 Coverage for Court-ordered Mental Health Services This section requires health plan companies that cover mental health services to also cover mental health services … 62Q.54 Referrals for Residents of Health Care Facilities Addresses referrals for residents of health care facilities under Minnesota health plan regulations. 62Q.545 Coverage of Home Care Nursing Addresses coverage of home care nursing under Minnesota health plan regulations. 62Q.55 Emergency Services Sets rules for emergency services coverage by health plans. 62Q.556 Consumer Protections Against Balance Billing This section prohibits balance billing in three situations: when an enrollee gets care from a nonparticipating provider … 62Q.56 Continuity of Care This section protects continuity of care when a health plan's contract with a provider ends or when an enrollee changes … 62Q.57 Designation of Primary Care Provider If a group health plan, or a non-grandfathered individual health plan, requires enrollees to designate a participating … 62Q.58 Access to Specialty Care This section requires health plans that mandate referrals to set up a process for enrollees to apply for a standing … 62Q.585 Gender-affirming Care Coverage; Medically Necessary Care This section bars any health plan that covers physical or mental health services from being offered, sold, issued, or … 62Q.64 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.645 Efficiency Reports and Distribution of Information This section lets the state commissioner use reports from health plan companies, service cooperatives, and the public … 62Q.65 Access to Provider Discounts When a high deductible health plan is used together with a medical savings account or a health savings account, this … 62Q.66 Durable Medical Equipment Coverage A health plan company that covers durable medical equipment cannot use medical coverage criteria that limit coverage … 62Q.665 Coverage for Orthotic and Prosthetic Devices This section requires health plans to cover orthotic and prosthetic devices, supplies, and services (including repair … 62Q.6651 Medical Necessity and Nondiscrimination Standards for Coverage of Prosthetics or Orthotics When reviewing requests for prosthetic or orthotic coverage, a health plan must apply the most recent evidence-based … 62Q.666 Intermittent Catheters A health plan must cover intermittent urinary catheters and insertion supplies when an enrollee's health care provider … 62Q.67 Disclosure of Covered Durable Medical Equipment Requires disclosure of covered durable medical equipment from health plans to consumers. 62Q.675 Hearing Aids A health plan must cover hearing aids for all individuals when the hearing loss is not correctable by other covered … 62Q.676 Medication Therapy Management A pharmacy benefit manager that provides prescription drug services must make medication therapy management services … 62Q.677 Lifetime and Annual Limits A health plan company offering individual or group coverage generally cannot set a lifetime or annual dollar limit on … 62Q.678 Dependent Child Notice This section requires group health plans and health plan companies offering coverage that includes dependent children to … 62Q.679 Religious Objections This section lets certain organizations with religious objections avoid providing some health coverage required under … 62Q.68 Definitions This section defines the terms used in sections 62Q.68 to 62Q.72, which deal with health plan company complaints. It … 62Q.69 Complaint Resolution This section requires every health plan company to set up an internal process for resolving complaints, which a … 62Q.70 Appeal of the Complaint Decision This section requires each health plan company to set up an internal process to appeal a complaint decision made under … 62Q.71 Notice to Enrollees Requires each health plan company to give enrollees a clear, concise written description of its complaint resolution … 62Q.72 Record Keeping; Reporting Requires each health plan company to keep records of all enrollee complaints and how they were resolved, retain those … 62Q.73 External Review of Adverse Determinations Establishes external review of adverse determinations procedures for health plan decisions. 62Q.731 Appeal From Adverse Determination This section gives an enrollee of the Comprehensive Health Association (the state high-risk health coverage pool) a way … 62Q.732 Citation This is a short-title (citation) section. It provides that sections 62Q.732 to 62Q.75 may be cited together as the … 62Q.733 Definitions Defines key terms used in Minnesota's health plan regulation laws. 62Q.734 Exemption Exempts small health plan companies from sections 62Q.735 to 62Q.739 and 62Q.74. The exemption applies when a company's … 62Q.735 Provider Contracting Procedures Governs provider contracting procedures requirements for health plans. 62Q.736 Payment Rates Requires that any contract between a health plan company and a provider comply with section 62A.64. This is a brief … 62Q.737 Service Code Changes Governs how health plan companies handle service codes (such as CPT, CDT, ICD-CM, and DRG codes) when adjudicating … 62Q.739 Unilateral Terms Prohibited This section governs contracts between a health plan company and a health care provider. The contract cannot contain … 62Q.74 Network Shadow Contracting This section, on "network shadow contracting," stops a health plan company from forcing a health care provider into a … 62Q.745 This section is reserved or has been repealed in the health plan regulation chapter. 62Q.746 Access to Certain Information Regarding Providers This section requires a health plan company licensed under chapters 62C and 62D to give the commissioner certain … 62Q.75 Prompt Payment Required This section requires health plan companies and third-party administrators to pay or deny a "clean claim" (a claim with … 62Q.751 Collecting Deductibles and Coinsurance Regulates collecting deductibles and coinsurance in health plans. 62Q.76 Definitions Defines the terms used in sections 62Q.76 to 62Q.79, which govern dental plans and dental organizations. It sets the … 62Q.77 Terms of Coverage Disclosure Requires a dental organization to make available to an enrollee, on request, a clear and concise description of the … 62Q.78 Dental Benefit Plan Requirements Sets rules that dental organizations must follow in their dealings with dentists, group purchasers, and enrollees. It … 62Q.79 Limitations Sets two limits on the disclosure duties that section 62Q.77 places on dental organizations. A dental organization does … 62Q.80 Community-based Health Care Coverage Program Authorizes a community-based health initiative (a nonprofit governed by a board with at least 80 percent community … 62Q.81 Essential Health Benefit Package Requirements Addresses essential health benefit package requirements under Minnesota health plan regulations. 62Q.82 Benefits and Coverage Explanation Requires health plan companies to give a summary of benefits and coverage explanation, as required by the Affordable … 62Q.83 Formulary Changes Limits when a health plan can change its drug formulary mid-year against an enrollee. For an enrollee who was already …