1.1Senator Abeler moved to amend
S.F. No. 3295 as follows (...):
1.2Page 147, after line 21, insert:
1.3 "Section 1. Minnesota Statutes 2024, section 62A.01, is amended by adding a subdivision
1.4to read:
1.5 Subd. 5. Direct primary care service agreements. (a) A direct primary care service
1.6agreement under section 62Q.20 is not insurance and is not subject to this chapter.
Entering
1.7into a direct primary care service agreement is not the business of insurance and
is not
1.8subject to this chapter or chapter 60A.
1.9(b) A health care provider or agent of a health care provider is not required to obtain
a
1.10certificate of authority or license under this chapter or chapter 60A, 62C, 62D, or
62N to
1.11market, sell, or offer to sell a direct primary care service agreement that meets
the
1.12requirements of section 62Q.20.
1.13 Sec. 2. Minnesota Statutes 2024, section 62A.011, subdivision 3, is amended to read:
1.14 Subd. 3.
Health plan. "Health plan" means a policy or certificate of accident and sickness
1.15insurance as defined in section
62A.01 offered by an insurance company licensed under
1.16chapter 60A; a subscriber contract or certificate offered by a nonprofit health service
plan
1.17corporation operating under chapter 62C; a health maintenance contract or certificate
offered
1.18by a health maintenance organization operating under chapter 62D; a health benefit
certificate
1.19offered by a fraternal benefit society operating under chapter 64B; or health coverage
offered
1.20by a joint self-insurance employee health plan operating under chapter 62H. Health
plan
1.21means individual and group coverage, unless otherwise specified. Health plan does
not
1.22include coverage that is:
1.23(1) limited to disability or income protection coverage;
1.24(2) automobile medical payment coverage;
1.25(3) liability insurance, including general liability insurance and automobile liability
1.26insurance, or coverage issued as a supplement to liability insurance;
1.27(4) designed solely to provide payments on a per diem, fixed indemnity, or
1.28non-expense-incurred basis, including coverage only for a specified disease or illness
or
1.29hospital indemnity or other fixed indemnity insurance, if the benefits are provided
under a
1.30separate policy, certificate, or contract for insurance; there is no coordination
between the
1.31provision of benefits and any exclusion of benefits under any group health plan maintained
1.32by the same plan sponsor; and the benefits are paid with respect to an event without
regard
2.1to whether benefits are provided with respect to such an event under any group health
plan
2.2maintained by the same plan sponsor;
2.3(5) credit accident and health insurance as defined in section
62B.02;
2.4(6) designed solely to provide hearing, dental, or vision care;
2.5(7) blanket accident and sickness insurance as defined in section
62A.11;
2.6(8) accident-only coverage;
2.7(9) a long-term care policy as defined in section
62A.46 or
62S.01;
2.8(10) issued as a supplement to Medicare, as defined in sections
62A.3099 to
62A.44, or
2.9policies, contracts, or certificates that supplement Medicare issued by health maintenance
2.10organizations or those policies, contracts, or certificates governed by section 1833
or 1876,
2.11section 1851, et seq.; or section 1860D-1, et seq., of title XVIII of the federal
Social Security
2.12Act, et seq., as amended;
2.13(11) workers' compensation insurance;
2.14(12) issued solely as a companion to a health maintenance contract as described in
section
2.1562D.12, subdivision 1a, so long as the health maintenance contract meets the definition of
2.16a health plan;
2.17(13) coverage for on-site medical clinics;
or
2.18(14) coverage supplemental to the coverage provided under United States Code, title
2.1910, chapter 55, Civilian Health and Medical Program of the Uniformed Services
2.20(CHAMPUS)
.; or
2.21(15) coverage provided under a direct primary care service agreement described under
2.22section 62Q.20.
2.23 Sec. 3.
[62Q.20] DIRECT PRIMARY CARE SERVICE AGREEMENT.
2.24 Subdivision 1. Definitions. (a) For purposes of this section, the following terms have
2.25the meanings given.
2.26(b) "Direct fee" means a fee charged by a direct primary care practice as consideration
2.27for being available to provide and for providing primary care services to a direct
patient as
2.28specified in the direct agreement.
2.29(c) "Direct patient" means an individual who is party to a direct agreement and is
entitled
2.30to receive primary care services under the direct agreement from the direct primary
care
2.31practice.
3.1(d) "Direct primary care practice" or "direct practice" means a primary care provider
3.2who furnishes primary care services through a direct agreement.
3.3(e) "Direct primary care service agreement" or "direct agreement" means a written
3.4agreement entered into between a direct primary care practice and a direct patient,
or the
3.5direct patient's legal representative, in which the primary care direct practice charges
a direct
3.6fee as consideration for being available to provide and for providing direct primary
care
3.7services to the direct patient.
3.8(f) "Primary care provider" means a physician who is licensed under chapter 147 or
an
3.9advanced practice registered nurse licensed under chapter 148, who is authorized to
engage
3.10in independent practice, and who is qualified to provide primary care services. This
term
3.11includes an individual primary care provider or a group of primary care providers.
3.12(g) "Primary care services" means:
3.13(1) routine health care services, including screening, assessment, diagnosis, and
treatment
3.14for the purpose of the promotion of health, and the detection and management of disease
3.15or injury within the competency and training of the primary care provider;
3.16(2) medical supplies and prescription drugs that are administered or dispensed in
the
3.17primary care provider's office or clinic; and
3.18(3) laboratory work, including routine blood screening and routine pathology screening
3.19performed by a laboratory that is either associated with the direct primary care practice
or
3.20is not associated with the direct primary care practice but has entered into a contract
with
3.21the practice to provide laboratory work without charging a fee to the patient for
the laboratory
3.22work.
3.23 Subd. 2. Direct primary care services agreement requirements. (a) To be considered
3.24a direct primary care service agreement for purposes of this section, the direct agreement
3.25must:
3.26(1) be in writing;
3.27(2) be signed by the primary care provider or agent of the primary care practice and
the
3.28direct patient or the patient's legal representative;
3.29(3) allow either party to terminate the direct agreement upon written notice to the
other
3.30party according to subdivision 3;
3.31(4) describe the scope of the primary care services that are to be covered under the
direct
3.32agreement;
4.1(5) specify the fee to be paid on a monthly basis or as specified in the direct agreement;
4.2and
4.3(6) specify the duration of the direct agreement.
4.4(b) The direct agreement must clearly state that a direct primary care service agreement:
4.5is not considered health insurance; does not meet the requirements of federal law
mandating
4.6individuals to purchase health insurance; and the fees charged in the agreement may
not be
4.7reimbursed or applied toward a deductible under a health plan offered through a health
plan
4.8company.
4.9 Subd. 3. Acceptance and discontinuance of patients. (a) A direct practice may not
4.10decline to accept a new patient or discontinue care to an existing patient solely
on the basis
4.11of the patient's health status. A direct practice may decline to accept a patient
if:
4.12(1) the practice has reached its maximum capacity;
4.13(2) the patient's medical condition is such that the practice is unable to provide
the level
4.14and type of primary care services the patient requires; or
4.15(3) the patient has previously terminated a direct agreement with the direct practice
4.16within the preceding year.
4.17(b) A direct patient or the patient's legal representative may terminate a direct
agreement
4.18for any reason by providing written notice to the direct practice. Termination of
the direct
4.19agreement is effective the first day of the month following the month the termination
notice
4.20is provided to the direct practice. A direct practice may subsequently decline to
accept the
4.21direct patient as a patient if the patient has terminated a previous direct agreement
with the
4.22direct practice within the preceding year.
4.23(c) A direct practice may terminate a direct agreement for any reason by providing
4.24written notice to the direct patient or the direct patient's representative. A direct
practice
4.25must provide notice of termination at least 30 days prior to the effective date of
termination.
4.26(d) A direct practice may discontinue care to a direct patient if the direct practice
4.27discontinues operation as a direct primary care practice. Notice must be provided
to the
4.28direct patient or the patient's legal representative specifying the effective date
of termination.
4.29Notice must be sufficient to provide the patient with the opportunity to obtain care
from
4.30another provider.
4.31 Subd. 4. Direct fees. (a) The direct fee charged must represent the total amount due for
4.32all primary care services specified in the direct agreement provided to the direct
patient
4.33within the specified time period. The direct fee must not vary from patient to patient
based
5.1on the patient's health status or sex. The direct fee may be paid by the direct patient,
by the
5.2patient's legal representative, or on the patient's behalf by a third party. The direct
fee may
5.3be billed at the end of each monthly period or may be paid in advance for a period
not to
5.4exceed 12 months.
5.5(b) Upon receipt of a written notice of termination of the direct agreement from a
direct
5.6patient or the patient's legal representative, the direct practice must promptly refund
the
5.7unearned amount of the direct fees. If the direct practice discontinues care for any
reason
5.8described under subdivision 3, the direct practice must promptly refund to the direct
patient
5.9the unearned amount of the direct fees at a prorated amount of the direct fee earned
for the
5.10current month based on the date the notice for termination was sent to the direct
patient or
5.11the direct patient's legal representative.
5.12(c) A direct practice shall not increase the monthly fee that has been negotiated
with an
5.13existing direct patient more frequently than on an annual basis. A direct practice
must
5.14provide advance notice of at least 60 days to existing patients of any change in the
direct
5.15fee.
5.16 Subd. 5. Conduct of business. (a) A direct practice must maintain appropriate accounts
5.17regarding payments made and services received by a direct patient and upon request
provide
5.18any data requested to the direct patient or the patient's legal representative.
5.19(b) A direct practice must not submit a claim for payment to a health plan company
for
5.20a primary care service provided to a direct patient that is covered by a direct agreement.
5.21(c) No person shall make, publish, or disseminate any false, deceptive, or misleading
5.22representation or advertising related to the business of a direct practice.
5.23(d) No person shall make, issue, or circulate, or cause to be made, issued, or circulated,
5.24a misrepresentation of the terms of a direct agreement or the benefits or advantages
promised,
5.25or use the name or title of a direct agreement misrepresenting the nature of the direct
5.26agreement.
5.27 Subd. 6. Other care not prohibited. A direct primary care practice is not prohibited
5.28from providing services to other patients under a separate contract with a health
plan
5.29company.
5.30 Subd. 7. Enforcement. A violation of this section shall constitute unprofessional conduct
5.31and may be grounds for disciplinary action under chapters 147 and 148."
5.32Renumber the sections in sequence and correct the internal references
5.33Amend the title accordingly
6.1The motion prevailed. #did not prevail. So the amendment was #not adopted.