Section 1 [Shared Savings Incentive Program]

Subdivision 1 provides definitions for purposes of the bill.

Subdivision 2 requires health plan companies to offer a shared savings incentive program to its enrollees beginning Jan 1, 2020. Description of the program must be filed with the commissioner of health, who must review it to ensure that it complies with this section.

Subdivision 3 requires the commissioner of health to develop a web-based interactive system for consumers to use to compare provider average charges for health care services.

Subdivision 4 requires a health plan company to establish a shared savings incentive account for each enrollee to receive deposits of incentive payments earned. Funds may be used to pay copayments, coinsurance, or deductibles. If out of pocket maximums have been met the funds may be used to pay insurance premiums.

Subdivision 5 establishes program requirements. The health plan company must provide incentives to an enrollee who receives a comparable health care service at less than the average allowed amount paid by the health plan company for that service. The enrollee must receive at least 50% of the saved costs. Calculation methodology for the incentive specified.

Subdivision 6 specifies methods to determine the average allowed amount for a service. Requires the health plan company to establish an interactive mechanism to allow an enrollee to request and obtain payment and quality data.

Subdivision 7 allows the enrollee to elect to use an out-of-network provider at the out-of-network price for the program. Health plan company must apply payments made by enrollee toward deductibles and out of pocket maximums upon request.

Subdivision 8 requires the health plan company to make the program a component of any health plan offered to a Minnesota resident. Notice about the program specified.

Subdivision 9 requires health care providers to post a patient’s ability to receive specified information to assist in comparing out of pocket and contracted amounts paid for care.

Subdivision 10 provides that a shared savings incentive payment is not an administrative expense for purposes of rate filing.

Subdivision 11 excludes public programs from the shared savings program.

Subdivision 12 requires reporting by the health plan company to the commissioner of health.

Subdivision 13 allows citation of this law as the “Patient Right To Shop Act”.