HF 38

as introduced - 90th Legislature (2017 - 2018) Posted on 02/13/2017 01:18pm

A bill for an act
relating to human services; increasing public transparency related to managed care
and county-based purchasing plan financial reporting; amending Minnesota Statutes
2016, section 256B.69, subdivisions 9a, 9c.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2016, section 256B.69, subdivision 9a, is amended to read:

Subd. 9a.

Administrative expense reporting.

Within the limit of available
appropriations, the commissioner shall work with the commissioner of health to identify
and collect data on administrative spending for state health care programs reported to the
commissioner of health by managed care plans under section 62D.08 and county-based
purchasing plans under section 256B.692, provided that such data are consistent with
guidelines and standards for administrative spending that are developed by the commissioner
of health, and reported to the legislature under Laws 2008, chapter 364, section 12. Data
provided to the commissioner under this subdivision are deleted text begin nonpublic deleted text end new text begin public new text end data as defined
under section 13.02.

Sec. 2.

Minnesota Statutes 2016, section 256B.69, subdivision 9c, is amended to read:

Subd. 9c.

Managed care financial reporting.

(a) The commissioner shall collect detailed
data regarding financials, provider payments, provider rate methodologies, and other data
as determined by the commissioner. The commissioner, in consultation with the
commissioners of health and commerce, and in consultation with managed care plans and
county-based purchasing plans, shall set uniform criteria, definitions, and standards for the
data to be submitted, and shall require managed care and county-based purchasing plans to
comply with these criteria, definitions, and standards when submitting data under this
section. In carrying out the responsibilities of this subdivision, the commissioner shall ensure
that the data collection is implemented in an integrated and coordinated manner that avoids
unnecessary duplication of effort. To the extent possible, the commissioner shall use existing
data sources and streamline data collection in order to reduce public and private sector
administrative costs. Nothing in this subdivision shall allow release of information that is
nonpublic data pursuant to section 13.02.

(b) Effective January 1, 2014, each managed care and county-based purchasing plan
must quarterly provide to the commissioner the following information on state public
programs, in the form and manner specified by the commissioner, according to guidelines
developed by the commissioner in consultation with managed care plans and county-based
purchasing plans under contract:

(1) an income statement by program;

(2) financial statement footnotes;

(3) quarterly profitability by program and population group;

(4) a medical liability summary by program and population group;

(5) received but unpaid claims report by program;

(6) services versus payment lags by program for hospital services, outpatient services,
physician services, other medical services, and pharmaceutical benefits;

(7) utilization reports that summarize utilization and unit cost information by program
for hospitalization services, outpatient services, physician services, and other medical
services;

(8) pharmaceutical statistics by program and population group for measures of price and
utilization of pharmaceutical services;

(9) subcapitation expenses by population group;

(10) third-party payments by program;

(11) all new, active, and closed subrogation cases by program;

(12) all new, active, and closed fraud and abuse cases by program;

(13) medical loss ratios by program;

(14) administrative expenses by category and subcategory by program that reconcile to
other state and federal regulatory agencies, including Minnesota Supplement Report #1A;

(15) revenues by program, including investment income;

(16) nonadministrative service payments, provider payments, and reimbursement rates
by provider type or service category, by program, paid by the managed care plan under this
section or the county-based purchasing plan under section 256B.692 to providers and vendors
for administrative services under contract with the plan, including but not limited to:

(i) individual-level provider payment and reimbursement rate data;

(ii) provider reimbursement rate methodologies by provider type, by program, including
a description of alternative payment arrangements and payments outside the claims process;

(iii) data on implementation of legislatively mandated provider rate changes; and

(iv) individual-level provider payment and reimbursement rate data and plan-specific
provider reimbursement rate methodologies by provider type, by program, including
alternative payment arrangements and payments outside the claims process, provided to the
commissioner under this subdivision are deleted text begin nonpublic deleted text end new text begin public new text end data as defined in section 13.02;

(17) data on the amount of reinsurance or transfer of risk by program; and

(18) contribution to reserve, by program.

(c) In the event a report is published or released based on data provided under this
subdivision, the commissioner shall provide the report to managed care plans and
county-based purchasing plans 15 days prior to the publication or release of the report.
Managed care plans and county-based purchasing plans shall have 15 days to review the
report and provide comment to the commissioner.

The quarterly reports shall be submitted to the commissioner no later than 60 days after the
end of the previous quarter, except the fourth-quarter report, which shall be submitted by
April 1 of each year. The fourth-quarter report shall include audited financial statements,
parent company audited financial statements, an income statement reconciliation report,
and any other documentation necessary to reconcile the detailed reports to the audited
financial statements.

(d) Managed care plans and county-based purchasing plans shall certify to the
commissioner for the purpose of financial reporting for state public health care programs
under this subdivision that costs reported for state public health care programs include:

(1) only services covered under the state plan and waivers, and related allowable
administrative expenses; and

(2) the dollar value of unallowable and nonstate plan services, including both medical
and administrative expenditures, that have been excluded.