1.1 A bill for an act
1.2 relating to insurance; allowing health carriers to offer reference-based pricing
1.3 health plans; proposing coding for new law in Minnesota Statutes, chapter 62K.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.5 Section 1. [62K.16] REFERENCE-BASED PRICING HEALTH PLAN.
1.6 Subdivision 1.General.Notwithstanding any law to the contrary and upon any necessary
1.7federal approval, a health carrier may offer in the individual, small, and large group market
1.8a reference-based pricing health plan that meets the requirements of this section.
1.9 Subd. 2.Provider participation.(a) A reference-based pricing health plan enrollee may
1.10access any health care provider who has agreed to (1) a reimbursement rate up to but not
1.11greater than the reimbursement rate specified in the enrollee's reference-based pricing plan
1.12as defined under this section, and (2) any other terms and conditions offered by the health
1.13carrier. Any terms and conditions offered by the health carrier must be the same for all
1.14health care providers who agree to participate in the health plan.
1.15 (b) A health carrier may require a participating provider to meet reasonable data,
1.16utilization review, and quality assurance requirements.
1.17 (c) A provider who agrees to participate must provide services to all enrollees of the
1.18health plan if the provider's reimbursement rates are equal to or less than that specified in
1.19the enrollee's health plan.
1.20 Subd. 3.Reimbursement rates.(a) The reimbursement rates offered to providers who
1.21agree to participate in a reference-based pricing health plan must be based on a percentage
1Section 1.
25-01005 as introduced01/10/25 REVISOR RSI/CH
SENATE
STATE OF MINNESOTA
S.F. No. 622NINETY-FOURTH SESSION
(SENATE AUTHORS: GRUENHAGEN, Lieske and Hoffman)
OFFICIAL STATUSD-PGDATE
Introduction and first reading01/27/2025
Referred to Commerce and Consumer Protection 2.1relative to the rates defined by the most recent Medicare reimbursement schedules
2.2promulgated by the Centers for Medicare and Medicaid Services.
2.3 (b) For services that do not have a corresponding Medicare reimbursement value, the
2.4health carrier must negotiate the rates based on other fee schedules used within the health
2.5care market.
2.6 (c) If a reference-based pricing health plan's reimbursement rate is at least 120 percent
2.7above the Medicare rate and the health plan is offered in all counties throughout Minnesota,
2.8the health plan is exempt from the geographic and network adequacy requirements under
2.9section 62K.10.
2.10 (d) A provider who agrees to participate in the health plan agrees to accept the
2.11reimbursement rate as payment in full under the terms of the health plan in accordance with
2.12section 62K.11.
2.13 Subd. 4.Conditions.(a) Nothing in this section requires a provider to participate in a
2.14reference-based pricing health plan. A health carrier is prohibited from requiring, as a
2.15condition of participation in any other health plan, product, or other arrangement offered
2.16by the health carrier, that the provider participate in a reference-based pricing health plan.
2.17 (b) Nothing in this section requires a health carrier to provide coverage for a service or
2.18treatment that is not covered under the enrollee's health plan.
2.19 (c) A reference-based pricing health plan may impose cost-sharing requirements,
2.20including co-payments, deductibles, and coinsurance, and reasonable referral and prior
2.21authorization requirements.
2.22 Subd. 5.Definitions.(a) For purposes of this section, the following terms have the
2.23meaning given them.
2.24 (b) "Provider" has the meaning given in section 62J.03, subdivision 8.
2.25 (c) "Reference-based pricing health plan" means a health plan in which the employer
2.26pays a set price for each service instead of negotiating prices with providers.
2Section 1.
25-01005 as introduced01/10/25 REVISOR RSI/CH