62Q.45 COVERAGE FOR OUT-OF-AREA PRIMARY CARE.
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62Q.45 COVERAGE FOR OUT-OF-AREA PRIMARY CARE.
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Subdivision 1. Study.
The commissioner of health shall develop methods to allow enrollees of managed care organizations to obtain primary care health services outside of the service area of their managed care organization, from health care providers who are employed by or under contract with another managed care organization. The commissioner shall make recommendations on:
(1)whether this out-of-area primary care coverage should be available to students and/or other enrollees without additional premium charges or cost sharing;
(2)methods to coordinate the services provided by different managed care organizations;
(3)methods to manage the quality of care provided by different managed care organizations and monitor health care outcomes;
(4)methods to reimburse managed care organizations for care provided to enrollees of other managed care organizations; and
(5)other issues relevant to the design and administration of out-of-area primary care coverage. The commissioner shall present recommendations to the legislature by January 15, 1996.
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Subd. 2. Definition.
For purposes of this section, "managed care organization" means:
(1)a health maintenance organization operating under chapter 62D;
(2)a community integrated service network as defined under section 62N.02, subdivision 4a ; or
(3)an insurance company licensed under chapter 60A, nonprofit health service plan corporation operating under chapter 62C, fraternal benefit society operating under chapter 64B, or any other health plan company, to the extent that it covers health care services delivered to Minnesota residents through a preferred provider organization or a network of selected providers.