HF 2927

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 03/18/2010 11:54am

A bill for an act
relating to health; providing administrative simplification by adding a health
care clearinghouse for health care provider transactions; amending Minnesota
Statutes 2008, sections 62J.51, by adding subdivisions; 62J.536, subdivisions 1,
2b, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2008, section 62J.51, is amended by adding a subdivision
to read:

new text begin Subd. 11a. new text end

new text begin Health care clearinghouse. new text end

new text begin "Health care clearinghouse" means
a public or private entity, including a billing service, repricing company, community
health management information system or community health information system, and
"value-added" networks and switches that does any of the following functions:
new text end

new text begin (1) processes or facilitates the processing of health information received from
another entity in a nonstandard format or containing nonstandard data content into
standard data elements or a standard transaction;
new text end

new text begin (2) receives a standard transaction from another entity and processes or facilitates
the processing of health information into nonstandard format or nonstandard data content
for the receiving entity;
new text end

new text begin (3) acts on behalf of a group purchaser in sending and receiving standard transactions
to assist the group purchaser in fulfilling its responsibilities under section 62J.536;
new text end

new text begin (4) acts on behalf of a health care provider in sending and receiving standard
transactions to assist the health care provider in fulfilling its responsibilities under section
62J.536; and
new text end

new text begin (5) other activities including but not limited to training, testing, editing, formatting,
or consolidation transactions.
new text end

new text begin A health care clearinghouse acts as an agent of a health care provider or group
purchaser only if it enters into an explicit, mutually agreed upon arrangement or contract
with the provider or group purchaser to perform specific clearinghouse functions.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62J.51, is amended by adding a subdivision to
read:

new text begin Subd. 16a. new text end

new text begin Standard transaction. new text end

new text begin "Standard transaction" means a transaction
that is defined in Code of Federal Regulations, title 45, part 162.103, and that meets the
requirements of the single, uniform companion guides described in section 62J.536.
new text end

Sec. 3.

Minnesota Statutes 2008, section 62J.536, subdivision 1, is amended to read:

Subdivision 1.

Electronic claims and eligibility transactions required.

(a)
Beginning January 15, 2009, all group purchasers must accept from health care providers
the eligibility for a health plan transaction described under Code of Federal Regulations,
title 45, part 162, subpart L. Beginning July 15, 2009, all group purchasers must accept
from health care providers the health care claims or equivalent encounter information
transaction described under Code of Federal Regulations, title 45, part 162, subpart K.

(b) Beginning January 15, 2009, all group purchasers must transmit to providers the
eligibility for a health plan transaction described under Code of Federal Regulations, title
45, part 162, subpart L. Beginning December 15, 2009, all group purchasers must transmit
to providers the health care payment and remittance advice transaction described under
Code of Federal Regulations, title 45, part 162, subpart P.

(c) Beginning January 15, 2009, all health care providers must submit to group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning July 15, 2009, all health care
providers must submit to group purchasers the health care claims or equivalent encounter
information transaction described under Code of Federal Regulations, title 45, part 162,
subpart K.

(d) Beginning January 15, 2009, all health care providers must accept from group
purchasers the eligibility for a health plan transaction described under Code of Federal
Regulations, title 45, part 162, subpart L. Beginning December 15, 2009, all health care
providers must accept from group purchasers the health care payment and remittance
advice transaction described under Code of Federal Regulations, title 45, part 162, subpart
P.

new text begin (e) Beginning January 1, 2012, all health care providers, health care clearinghouses,
and group purchasers must provide an appropriate, standard, electronic acknowledgment
when receiving the health care claims or equivalent encounter information transaction or
the health care payment and remittance advice transaction. The acknowledgment provided
must be based on one or more of the following American National Standards Institute,
Accredited Standards Committee X12 standard transactions:
new text end

new text begin (1) TA1;
new text end

new text begin (2) 997;
new text end

new text begin (3) 999; or
new text end

new text begin (4) 277CA.
new text end

new text begin Health care providers, health care clearinghouses, and group purchasers may send and
receive more than one type of standard acknowledgment as mutually agreed upon. The
mutually agreed upon acknowledgments must be exchanged electronically. Electronic
exchanges of acknowledgments do not include e-mail or facsimile.
new text end

deleted text begin (e) deleted text end new text begin (f) new text end Each of the transactions described in paragraphs (a) to deleted text begin (d) deleted text end new text begin (e) new text end shall require the
use of a single, uniform companion guide to the implementation guides described under
Code of Federal Regulations, title 45, part 162. The companion guides will be developed
pursuant to subdivision 2.

deleted text begin (f) deleted text end new text begin (g) new text end Notwithstanding any other provisions in sections 62J.50 to 62J.61, all group
purchasers and health care providers must exchange claims and eligibility information
electronically using the transactions, companion guides, implementation guides, and
timelines required under this subdivision. Group purchasers may not impose any fee on
providers new text begin or providers' clearinghouses new text end for the use of the transactions prescribed in this
subdivision. new text begin Health care providers may not impose a fee on group purchasers or group
purchasers' clearinghouses for the use of the transactions prescribed in this subdivision.
A clearinghouse may not charge a fee solely to receive a standard transaction from a
health care provider, a health care provider's clearinghouse, a group purchaser, or a group
purchaser's clearinghouse when it is not an agent of the sending entity. A clearinghouse
may not charge a fee solely to send a standard transaction to a health care provider, a health
care provider's clearinghouse, a group purchaser, or a group purchaser's clearinghouse
when it is not an agent of the receiving entity.
new text end

deleted text begin (g) deleted text end new text begin (h) new text end Nothing in this subdivision shall prohibit group purchasers and health care
providers from using a direct data entry, Web-based methodology for complying with
the requirements of this subdivision. Any direct data entry method for conducting
the transactions specified in this subdivision must be consistent with the data content
component of the single, uniform companion guides required in paragraph deleted text begin (e) deleted text end new text begin (f) new text end and the
implementation guides described under Code of Federal Regulations, title 45, part 162.

Sec. 4.

Minnesota Statutes 2008, section 62J.536, subdivision 2b, is amended to read:

Subd. 2b.

Compliance and investigations.

(a) The commissioner of health shall,
to the extent practicable, seek the cooperation of health care providers new text begin , health care
clearinghouses, new text end and group purchasers in obtaining compliance with this section and may
provide technical assistance to health care providers new text begin , health care clearinghouses, new text end and
group purchasers.

(b) A person who believes a health care provider new text begin , health care clearinghouse, new text end or group
purchaser is not complying with the requirements of this section may file a complaint with
the commissioner of health. Complaints filed under this section must meet the following
requirements:

(1) A complaint must be filed in writing, either on paper or electronically.

(2) A complaint must name the person that is the subject of the complaint and
describe the acts or omissions believed to be in violation of this section.

(3) A complaint must be filed within 180 days of when the complainant knew or
should have known that the act or omission complained of occurred.

(4) The commissioner may prescribe additional procedures for the filing of
complaints as required to satisfy the requirements of this section.

(c) The commissioner of health may investigate complaints filed under this
section. The investigation may include a review of the pertinent policies, procedures,
or practices of the health care provider new text begin , health care clearinghouse, new text end or group purchaser
and of the circumstances regarding any alleged violation. At the time of initial written
communication with the health care provider new text begin , health care clearinghouse, new text end or group
purchaser about the complaint, the commissioner of health shall describe the acts or
omissions that are the basis of the complaint. The commissioner may conduct compliance
reviews to determine whether health care providers new text begin , health care clearinghouses, new text end and group
purchasers are complying with this section.

(d) Health care providers new text begin , health care clearinghouses, new text end and group purchasers must
cooperate with the commissioner of health if the commissioner undertakes an investigation
or compliance review of the policies, procedures, or practices of the health care provider new text begin ,
health care clearinghouse, new text end or group purchaser to determine compliance with this section.
This cooperation includes, but is not limited to:

(1) A health care provider new text begin , health care clearinghouse, new text end or group purchaser must permit
access by the commissioner of health during normal business hours to its facilities, books,
records, accounts, and other sources of information that are pertinent to ascertaining
compliance with this section.

(2) If any information required of a health care provider new text begin , health care clearinghouse, new text end
or group purchaser under this section is in the exclusive possession of any other agency,
institution, or person and the other agency, institution, or person fails or refuses to furnish
the information, the health care provider new text begin , health care clearinghouse, new text end or group purchaser
must so certify and set forth what efforts it has made to obtain the information.

(3) Any individually identifiable health information obtained by the commissioner
of health in connection with an investigation or compliance review under this section
may not be used or disclosed by the commissioner of health, except as necessary for
ascertaining or enforcing compliance with this section.

(e) If an investigation of a complaint indicates noncompliance, the commissioner
of health shall attempt to reach a resolution of the matter by informal means. Informal
means may include demonstrated compliance or a completed corrective action plan or
other agreement. If the matter is resolved by informal means, the commissioner of health
shall so inform the health care provider new text begin , health care clearinghouse, new text end or group purchaser
and, if the matter arose from a complaint, the complainant, in writing. If the matter is not
resolved by informal means, the commissioner of health shall:

(1) inform the health care provider new text begin , health care clearinghouse, new text end or group purchaser
and provide an opportunity for the health care provider new text begin , health care clearinghouse, new text end
or group purchaser to submit written evidence of any mitigating factors or other
considerations. The health care provider new text begin , health care clearinghouse, new text end or group purchaser
must submit any such evidence to the commissioner of health within 30 calendar days
of receipt of the notification; and

(2) inform the health care provider new text begin , health care clearinghouse, new text end or group purchaser,
through a notice of proposed determination according to paragraph (i), that the
commissioner of health finds that a civil money penalty should be imposed.

(f) If, after an investigation or a compliance review, the commissioner of health
determines that further action is not warranted, the commissioner of health shall so inform
the health care provider new text begin , health care clearinghouse, new text end or group purchaser and, if the matter
arose from a complaint, the complainant, in writing.

(g) A health care provider new text begin , health care clearinghouse, new text end or group purchaser may not
threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory
action against any individual or other person for:

(1) filing of a complaint under this section;

(2) testifying, assisting, or participating in an investigation, compliance review,
proceeding, or contested case proceeding under this section; or

(3) opposing any act or practice made unlawful by this section, provided the
individual or person has a good faith belief that the practice opposed is unlawful, and
the manner of opposition is reasonable and does not involve an unauthorized disclosure
of a patient's health information.

(h) The commissioner of health may impose a civil money penalty on a health care
provider new text begin , health care clearinghouse, new text end or group purchaser if the commissioner of health
determines that the health care provider new text begin , health care clearinghouse, new text end or group purchaser
has violated this section. If the commissioner of health determines that more than one
health care provider new text begin , health care clearinghouse, new text end or group purchaser was responsible for
a violation, the commissioner of health may impose a civil money penalty against each
health care provider new text begin , health care clearinghouse, new text end or group purchaser. The amount of a civil
money penalty shall be determined as follows:

(1) The amount of a civil money penalty shall be up to $100 for each violation, but
not exceed $25,000 for identical violations during a calendar year.

(2) In the case of continuing violation of this section, a separate violation occurs
each business day that the health care provider new text begin , health care clearinghouse, new text end or group
purchaser is in violation of this section.

(3) In determining the amount of any civil money penalty, the commissioner of health
may consider as aggravating or mitigating factors, as appropriate, any of the following:

(i) the nature of the violation, in light of the purpose of the goals of this section;

(ii) the time period during which the violation occurred;

(iii) whether the violation hindered or facilitated an individual's ability to obtain
health care;

(iv) whether the violation resulted in financial harm;

(v) whether the violation was intentional;

(vi) whether the violation was beyond the direct control of the health care provider new text begin ,
health care clearinghouse, new text end or group purchaser;

(vii) any history of prior compliance with the provisions of this section, including
violations;

(viii) whether and to what extent the provider new text begin , health care clearinghouse, new text end or group
purchaser has attempted to correct previous violations;

(ix) how the health care provider new text begin , health care clearinghouse, new text end or group purchaser
has responded to technical assistance from the commissioner of health provided in the
context of a compliance effort; or

(x) the financial condition of the health care provider new text begin , health care clearinghouse, new text end
or group purchaser including, but not limited to, whether the health care provider new text begin , health
care clearinghouse, new text end or group purchaser had financial difficulties that affected its ability to
comply or whether the imposition of a civil money penalty would jeopardize the ability
of the health care provider new text begin , health care clearinghouse, new text end or group purchaser to continue to
provide, or to pay for, health care.

(i) If a penalty is proposed according to this section, the commissioner of health
must deliver, or send by certified mail with return receipt requested, to the respondent
written notice of the commissioner of health's intent to impose a penalty. This notice
of proposed determination must include:

(1) a reference to the statutory basis for the penalty;

(2) a description of the findings of fact regarding the violations with respect to
which the penalty is proposed;

(3) the amount of the proposed penalty;

(4) any circumstances described in paragraph (i) that were considered in determining
the amount of the proposed penalty;

(5) instructions for responding to the notice, including a statement of the respondent's
right to a contested case proceeding and a statement that failure to request a contested case
proceeding within 30 calendar days permits the imposition of the proposed penalty; and

(6) the address to which the contested case proceeding request must be sent.

(j) A health care provider new text begin , health care clearinghouse, new text end or group purchaser may contest
whether the finding of facts constitute a violation of this section, according to a contested
case proceeding as set forth in sections 14.57 to 14.62, subject to appeal according to
sections 14.63 to 14.68.

(k) Any data collected by the commissioner of health as part of an active
investigation or active compliance review under this section are classified as protected
nonpublic data pursuant to section 13.02, subdivision 13, in the case of data not on
individuals and confidential pursuant to section 13.02, subdivision 3, in the case of data
on individuals. Data describing the final disposition of an investigation or compliance
review are classified as public.

(l) Civil money penalties imposed and collected under this subdivision shall be
deposited into a revolving fund and are appropriated to the commissioner of health for the
purposes of this subdivision, including the provision of technical assistance.

Sec. 5.

Minnesota Statutes 2008, section 62J.536, is amended by adding a subdivision
to read:

new text begin Subd. 4. new text end

new text begin Health care clearinghouses. new text end

new text begin (a) Beginning January 1, 2012, health care
clearinghouses must use and make available suitable tracking mechanisms to allow
health care providers and group purchasers to determine in a timely fashion that health
care claims or equivalent encounter information transactions and health care payment
and remittance advice transactions were delivered to their intended final destination.
Clearinghouses must provide clear, understandable, accurate information and instructions
for tracking claims and remittance advice transactions to all clients, potential clients,
or interested parties. Clearinghouses must provide clear, accurate information and
instructions for receiving and responding to questions or concerns from health care
providers or group purchasers regarding tracking of health care claims and remittance
advice transactions. This information must include any designated points of contact and
contact information, hours of operation, and other information to assist providers and
group purchasers with questions or concerns.
new text end

new text begin (b) Health care clearinghouses must make or provide electronic connections
with other clearinghouses or trading partners requesting such a connection to meet the
requirements of this section. A health care clearinghouse must connect electronically in
a timely manner with any entity willing and capable of meeting the standard business
terms and conditions of the clearinghouse, as well as any applicable laws and regulations.
Any connectivity sought or established under this subdivision must be consistent with
this section and with other applicable laws and rules. Health care providers and group
purchasers may determine which clearinghouses they choose to work with and which
to enter into agent relationships.
new text end

new text begin (c) Acceptance of a compliant standard transaction may not be contingent on
purchase of additional services. A health care clearinghouse may not condition acceptance
of a compliant standard transaction from a provider, provider's agent, group purchaser, or
group purchaser's agent on the provider's or group purchaser's agreement to pay for an
additional service such as transmitting attachments electronically.
new text end

new text begin (d) The commissioner may:
new text end

new text begin (1) require information and data from health care clearinghouses, including
information regarding clearinghouse operations and performance, to ensure that
requirements of this section and related rules are fulfilled;
new text end

new text begin (2) require that clearinghouses with Web sites post, maintain, and regularly update
on their Web sites point-of-contact information and other information needed by clients,
potential clients, and others to obtain answers to questions or to conduct business;
new text end

new text begin (3) require that all clearinghouses provide timely, clear, accurate, reliable information
to their clients, potential clients, or any interested parties regarding their products or
services, pricing, and other business and service information; and
new text end

new text begin (4) post information from clearinghouses on a Department of Health Web site and
make the information broadly available through other means.
new text end

new text begin The commissioner shall determine the manner, content, timing, frequency, and other
specifications for information to be posted or submitted by health care clearinghouses.
new text end

Sec. 6. new text begin NONSUBMISSION OF HEALTH CARE CLAIM BY
CLEARINGHOUSE; SIGNIFICANT DISRUPTION.
new text end

new text begin A situation shall be considered a significant disruption to normal operations that
materially affects the provider's or facility's ability to conduct business in a normal manner
and to submit claims on a timely basis under Minnesota Statutes, section 62Q.75, if:
new text end

new text begin (1) a clearinghouse loses, or otherwise does not submit, a health care claim as
required by Minnesota Statutes, section 62J.536; and
new text end

new text begin (2) the provider or facility can substantiate that it submitted a complete claim to the
clearinghouse within provisions stated in contract or six months of the date of service,
whichever is less.
new text end

new text begin This section expires January 1, 2012.
new text end