1.2relating to commerce; prohibiting noncovered discounts for vision care provided
1.3by health and vision plans; adding optometrists to a definition of health care
1.4provider;amending Minnesota Statutes 2012, section 62Q.74, subdivision 1;
1.5proposing coding for new law in Minnesota Statutes, chapter 62Q.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7    Section 1. Minnesota Statutes 2012, section 62Q.74, subdivision 1, is amended to read:
1.8    Subdivision 1. Definitions. (a) For purposes of this section, "category of coverage"
1.9means one of the following types of health-related coverage:
1.10(1) health;
1.11(2) no-fault automobile medical benefits; or
1.12(3) workers' compensation medical benefits.
1.13(b) "Health care provider" or "provider" means a physician, chiropractor,
1.14optometrist, ophthalmologist, dentist, podiatrist, hospital, ambulatory surgical center,
1.15freestanding emergency room, or other provider, as defined in section 62J.03.

1.16    Sec. 2. [62Q.741] PROHIBITION OF NONCOVERED DISCOUNTS; VISION
1.17CARE PROVIDED BY HEALTH AND VISION PLANS.
1.18    Subdivision 1. Definitions. For purposes of this section:
1.19(a) "Contractual discount" means a percentage reduction from a provider's usual
1.20and customary rate for covered services and materials required under a participating
1.21provider agreement.
1.22(b) "Covered services" means services and materials for which reimbursement
1.23from the vision plan is provided for by an enrollee's plan or contract, or for which a
2.1reimbursement would be available but for the application of the enrollee's contractual
2.2limitations of deductibles, co-payments, and coinsurance.
2.3(c) "Health care provider" or "provider" has the meaning given in section 62Q.74,
2.4subdivision 1, paragraph (b).
2.5(d) "Materials" includes but is not limited to lenses, devices containing lenses,
2.6prisms, lens treatments and coatings, contact lenses, orthoptics, vision training, and
2.7prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human
2.8eye or its adnexa.
2.9    Subd. 2. Noncovered vision care under health or vision plans prohibited.
2.10No contract or other agreement between an insurer or another entity that writes vision
2.11insurance and an optometrist or ophthalmologist, for the provision of vision services on a
2.12preferred or in-network basis to plan members or insurance subscribers in connection with
2.13coverage under a stand-alone vision plan, a medical plan, or a health insurance policy,
2.14may require that an optometrist or ophthalmologist provide services or materials at a fee
2.15limited or set by the plan or insurer unless the services or materials are reimbursed as
2.16covered services under the contract or other agreement.
2.17    Subd. 3. Provider charges, contractual discounts, and nominal reimbursements.
2.18(a) A provider shall not charge more for services and materials that are noncovered
2.19services and materials under a vision plan than the provider's usual and customary rate
2.20for those services and materials.
2.21(b) The amount of a contractual discount shall not result in a fee less than the health
2.22or vision plan would pay for covered services and materials, but for the application of an
2.23enrollee's contractual limitations of deductibles, co-payments, and coinsurance.
2.24(c) Reimbursement paid by the vision plan for covered services and materials shall
2.25be reasonable and shall not provide nominal or de minimis reimbursement in order to
2.26claim that services and materials are covered services.

2.27    Sec. 3. EFFECTIVE DATE.
2.28Sections 1 and 2 are effective August 1, 2014, and apply to health or vision plans
2.29offered, sold, issued, or renewed on or after that date.