HF 2241

as introduced - 87th Legislature (2011 - 2012) Posted on 02/13/2012 11:58am

A bill for an act
relating to health; requiring certain changes in managed care plan financial
reporting; requiring an annual independent third-party audit; amending
Minnesota Statutes 2011 Supplement, section 256B.69, subdivision 9c.

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

Section 1.

Minnesota Statutes 2011 Supplement, 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 and managed care and county-based
purchasing plans that are required to be submitted under this section. 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) Each managed care and county-based purchasing plan must annually 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) administrative expenses by category and subcategory consistent with
administrative expense reporting to other state and federal regulatory agencies, by
program;

(2) revenues by program, including investment income;

(3) 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 nonpublic data as defined in section 13.02;

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

(5) 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 30 days prior to the publication or release of the report.
Managed care plans and county-based purchasing plans shall have 30 days to review the
report and provide comment to the commissioner.

new text begin (d) The commissioner shall require, in the request for bids and the resulting
contracts for coverage to be provided under this section, that each managed care and
county-based purchasing plan submit to and fully cooperate with an annual independent
third-party financial audit of the information required under paragraph (b). For purposes
of this paragraph, "independent third party" means that the audit must be conducted
by a firm that performs audits only for governmental entities and does not provide or
receive, and has not provided or received, payment for actuarial, auditing, accounting,
or other services provided by the firm, or by any affiliate of the firm, to a managed care
or county-based purchasing plan, or to any affiliate of either, that is awarded a contract
with the commissioner under this section.
new text end

new text begin (e) The commissioner shall not contract, for purposes of this section, with a firm
that provides consulting or other services to a participating managed care or county-based
purchasing plan, regardless of whether the consulting services are related to health care
provided under this section.
new text end

new text begin (f) A managed care plan or county-based purchasing plan that provides services
under this section shall provide complete real-time encounter and claims data at the
granular or source level regarding those services to the commissioner and shall, upon
request of the commissioner, promptly provide the commissioner and the independent
third-party auditing firm with auditable proof that the encounters and claims are occurring
as reported.
new text end

new text begin (g) Contracts awarded under this section to a managed care or county-based
purchasing plan must provide that the commissioner and the contracted auditor shall have
unlimited access to any and all data required to complete the audit and that this access
shall be enforceable in a court of competent jurisdiction through the process of injunctive
or other appropriate relief.
new text end

new text begin (h) No actuary or actuarial firm providing actuarial services to the commissioner
in connection with this subdivision shall provide services to any managed care or
county-based purchasing plan participating in this subdivision during the term of the
actuary's work for the commissioner under this subdivision.
new text end

new text begin (i) The actuary or actuarial firm referenced in paragraph (h) shall certify and attest
to the rates paid to managed care plans and county-based purchasing plans under this
section, and the certification and attestation must be auditable.
new text end

new text begin (j) The independent third-party audit shall include a determination of compliance
with the federal Medicaid rate certification process.
new text end

new text begin (k) The commissioner's contract with the independent third-party auditing firm shall
be designed and administered so as to render the independent third-party audit eligible for
a federal subsidy if available for that purpose.
new text end

new text begin (l) Upon completion of the audit, and its receipt by the commissioner, the
commissioner shall provide copies of the audit report to the legislative auditor, the attorney
general, and the chairs of the health finance committees of the legislature.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment
and applies to contracts, and the contracting process, for contracts that are effective
January 1, 2013, and thereafter.
new text end