MN HF1352

Health carriers must offer at least one health plan in individual and small group markets that is open to all licensed health care providers in the state who accept the same terms and conditions offered to all network providers.

Health carriers may require providers to meet reasonable referral, utilization review, and quality assurance requirements applied consistently to all network providers.

Negotiated payment rates must be at least 120 percent of Medicare Physician Fee Schedule rates, or at least 140 percent for primary care providers certified as health care homes.

Health carriers cannot impose co-payments, fees, or cost-sharing requirements for selecting network providers, though uniform cost-sharing may apply equally to all providers within the plan.

Providers are not required to contract with a health carrier or accept any specific payment rate, and health carriers remain obligated only to cover services included in the enrollee's health plan.