The bill SF No 622 describes a new option in Minnesota for health insurance plans called "reference-based pricing health plans." This type of plan allows insurance companies (health carriers) to offer plans where costs for medical services are predefined relative to Medicare reimbursement rates. Here are key points about the bill:

1. General Provision: Health carriers can offer these plans in individual, small, and large group markets once they receive any necessary federal approvals.

2. Provider Participation:

   • Patients can only use health care providers who agree to the payment limits set by their specific plan.
   • Providers must accept the payment terms as full compensation for services rendered.
   • Health carriers can set requirements for providers concerning data handling, utilization reviews, and quality assurances.
   • Providers agree to treat all members of the plan if their rates match the plan's set rates.

3. Setting Reimbursement Rates:

   • Rates for providers will be pegged to a percentage of what Medicare reimburses for similar services.
   • For services lacking a Medicare rate, the health carrier must negotiate rates using other standard health care market fees.
   • Plans paying at least 120% above the Medicare rate and offered throughout Minnesota may not need to meet certain geographic and network adequacy rules.

4. Operational Conditions:

   • Participation by providers in these plans is voluntary and cannot be forced as a condition to participate in other health plans offered by the carrier.
   • These plans are not obligated to cover services not included in the enrollee's plan.
   • Plans can include typical cost-sharing terms like co-payments, deductibles, and coinsurance, and may require prior authorization or referrals.

5. Definitions:

   • The bill specifies what constitutes a "provider" and defines a "reference-based pricing health plan" as one where a set payment is made for each service rather than negotiating prices with providers.

Overall, this bill aims to allow more preset pricing structures in health care to potentially simplify and control costs within the health care system in Minnesota.