MN HF4396

Health plan companies must offer provider contracts to all designated essential community providers located within their service areas and include those providers in every health plan issued by the company.

Health plan companies cannot restrict enrollee access to services provided by essential community providers for the populations they are certified to serve, though other providers may also be made available.

Essential community providers must meet the same data requirements, utilization review, and quality assurance requirements as other health plan providers.

Payment rates for essential community providers must be at least equal to the rate per unit of service paid under the health plan company's largest existing product with that provider, or if no product exists, equal to rates paid to other providers for the same or similar services.

The requirements are effective January 1, 2025, and apply to health plans offered, issued, or renewed on or after that date.