Minnesota Legislature
HF 800
as introduced - 87th Legislature (2011 - 2012) Posted on 03/03/2011 10:44am
Current Version - as introduced
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A bill for an act
relating to human services; specifying applicability of antitrust laws to the
prepaid medical assistance program; amending Minnesota Statutes 2010, section
256B.69, subdivision 5k.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2010, section 256B.69, subdivision 5k, is amended to
read:
Subd. 5k.
Actuarial soundness.
(a) Rates paid to managed care plans and
county-based purchasing plans shall satisfy requirements for actuarial soundness. In order
to comply with this subdivision, the rates must:
(1) be neither inadequate nor excessive;
(2) satisfy federal requirements;
(3) in the case of contracts with incentive arrangements, not exceed 105 percent of
the approved capitation payments attributable to the enrollees or services covered by
the incentive arrangement;
(4) be developed in accordance with generally accepted actuarial principles and
practices;
(5) be appropriate for the populations to be covered and the services to be furnished
under the contract; deleted text begin and
deleted text end
(6) be certified as meeting the requirements of federal regulations by actuaries who
meet the qualification standards established by the American Academy of Actuaries and
follow the practice standards established by the Actuarial Standards Boardnew text begin ; and
new text end
new text begin (7) not be based upon or the result of any violation of sections 325D.49 to 325D.66
by any managed care plan or county-based purchasing plan. The exemption in section
325D.55, subdivision 2, paragraph (a), does not apply to this sectionnew text end .
(b) Each year within 30 days of the establishment of plan rates the commissioner
shall report to the chairs and ranking minority members of the senate Health and Human
Services Budget Division and the house of representatives Health Care and Human
Services Finance Division to certify how each of these conditions have been met by
the new payment rates.