1.1                          A bill for an act
  1.2             relating to health; requiring prompt payments by 
  1.3             health maintenance organizations and nonprofit health 
  1.4             service plan corporations of certain claims made by 
  1.5             home care providers; requiring claim errors to be 
  1.6             reported within a certain time; establishing 
  1.7             penalties; proposing coding for new law in Minnesota 
  1.8             Statutes, chapter 62D. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  [62D.108] [PROMPT PAYMENTS TO HOME CARE 
  1.11  PROVIDERS.] 
  1.12     Subdivision 1.  [APPLICABILITY.] This section applies to 
  1.13  health maintenance organizations regulated under this chapter. 
  1.14     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
  1.15  following terms have the meanings given them: 
  1.16     (1) "clean claim" means an original paper or electronic 
  1.17  claim with correct data elements, prepared in accordance with 
  1.18  the health maintenance organization's published specifications 
  1.19  for claims preparation, that does not require an attachment or 
  1.20  text information to pay or deny the claim; 
  1.21     (2) "home care provider" has the meaning given in section 
  1.22  144A.43, subdivision 4; and 
  1.23     (3) "valid home care provider claim" means a clean claim 
  1.24  submitted directly to the health maintenance organization by an 
  1.25  eligible home care provider for home care services provided to 
  1.26  an eligible enrollee. 
  1.27     Subd. 3.  [CLAIMS PAYMENTS TO HOME CARE PROVIDERS.] Health 
  2.1   maintenance organizations must pay or deny a valid home care 
  2.2   provider claim for home care services within 30 days of 
  2.3   receiving the claim.  A health maintenance organization that has 
  2.4   notified a home care provider of an incorrect, defective, or 
  2.5   improper claim shall pay or deny the claim within 30 days of 
  2.6   receipt of all additional necessary information.  If additional 
  2.7   information is required to complete the processing of the claim, 
  2.8   other than information from the home care provider, the health 
  2.9   maintenance organization shall disclose to the home care 
  2.10  provider as to the nature of the additional information 
  2.11  consistent with state and federal law, necessary to process the 
  2.12  claim.  Where evidence of suspected fraud is present, the 
  2.13  requirement to disclose additional information need not be 
  2.14  specific. 
  2.15     Subd. 4.  [PAYMENT OF INTEREST ON LATE PAYMENTS.] (a) If a 
  2.16  health maintenance organization fails to pay or deny a valid 
  2.17  home care provider claim within 30 days as specified in 
  2.18  subdivision 3 or 30 days from the receipt of all additional 
  2.19  necessary information as provided in subdivision 3, the health 
  2.20  maintenance organization must pay interest to the home care 
  2.21  provider on the claim with interest accruing from the 30th day.  
  2.22  If a negotiated contract or agreement between a home care 
  2.23  provider and a health maintenance organization requires an audit 
  2.24  by the health maintenance organization before acceptance and 
  2.25  payment of the claim, interest payments do not apply until 30 
  2.26  days after the timely completion of the audit by the health 
  2.27  maintenance organization.  Before any interest payment is made, 
  2.28  the home care provider must bill the health maintenance 
  2.29  organization for the interest.  
  2.30     (b) The rate of interest paid by a health maintenance 
  2.31  organization under this subdivision shall be 1.5 percent per 
  2.32  month or any part of the month. 
  2.33     (c) A home care provider who prevails in a civil action to 
  2.34  collect interest payments from a health maintenance organization 
  2.35  shall be awarded the costs and disbursements, including attorney 
  2.36  fees, incurred in bringing the action. 
  3.1      (d) The minimum monthly interest payment that a health 
  3.2   maintenance organization must pay to a home care provider for 
  3.3   the unpaid balance for any single overdue claim equal to or 
  3.4   exceeding $100 is $10.  For unpaid balances of less than $100, 
  3.5   the health maintenance organization must pay the actual interest 
  3.6   payment due to the home care provider. 
  3.7      (e) A health maintenance organization is not required to 
  3.8   make an interest payment on a claim for which payment has been 
  3.9   delayed for purposes of reviewing potentially fraudulent or 
  3.10  abusive billing practices. 
  3.11     Subd. 5.  [CLAIMS ERRORS.] For purposes of payments made to 
  3.12  home care providers receiving reimbursement from a health 
  3.13  maintenance organization, a health maintenance organization that 
  3.14  receives a claim that is incorrect, defective, or otherwise 
  3.15  improper must notify the home care provider of any errors within 
  3.16  30 days of discovery of the error. 
  3.17     Sec. 2.  [EFFECTIVE DATE.] 
  3.18     Section 1 is effective July 1, 1999, and applies to claims 
  3.19  made under health maintenance organization contracts with home 
  3.20  care providers entered into or renewed on or after that date.