62Q.096 CREDENTIALING OF PROVIDERS.

340 words·~2 min read·/mn/chapter-62/62q-096

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)If a health plan company has initially credentialed, as providers in its provider network, individual providers employed by or under contract with an entity that:

(1)is authorized to bill under section 256B.0625, subdivision 5 ;

(2)is a mental health clinic certified under section 245I.20 ;

(3)is designated an essential community provider under section 62Q.19 ; and

(4)is under contract with the health plan company to provide mental health services, the health plan company must continue to credential at least the same number of providers from that entity, as long as those providers meet the health plan company's credentialing standards.

(b)In order to ensure timely access by patients to mental health services, between July 1, 2023, and June 30, 2025, a health plan company must credential and enter into a contract for mental health services with any provider of mental health services that:

(1)meets the health plan company's credential requirements. For purposes of credentialing under this paragraph, a health plan company may waive credentialing requirements that are not directly related to quality of care in order to ensure patient access to providers from underserved communities or to providers in rural areas;

(2)seeks to receive a credential from the health plan company;

(3)agrees to the health plan company's contract terms. The contract shall include payment rates that are usual and customary for the services provided;

(4)is accepting new patients; and

(5)is not already under a contract with the health plan company under a separate tax identification number or, if already under a contract with the health plan company, has provided notice to the health plan company of termination of the existing contract.

(c)A health plan company shall not refuse to credential these providers on the grounds that their provider network has:

(1)a sufficient number of providers of that type, including but not limited to the provider types identified in paragraph (a); or

(2)a sufficient number of providers of mental health services in the aggregate.